Survivorship Care Plans: What are they and why do I need one?

Posted March 6th, 2018 by Be The Match and filed in News
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Linda Burns, M.D., Be The Match Vice President and Medical Director, HealthServices Research

A Survivorship Care Plan is a complete record of your medical history, all the treatments given before, during and after transplant, and what follow-up care you need to stay healthy. They keep your recovery on track by helping you coordinate your health care between the different doctors, nurses, social workers, and others that you’ll see after your transplant.

“The usual time to provide a Survivorship Care Plan to a transplant recipient is at about 12 months after the transplant,” says Linda Burns, M.D., Be The Match Vice President and Medical Director, Health Services Research. Many of the transplant care needs are decreasing by then, she notes, and the focus begins to shift to helping you stay healthy in the years to come.

What should a Survivorship Care Plan include?

Your plan should say which person on your health care team is responsible for which part of your ongoing care, says Dr. Burns. A Survivorship Care Plan is your personal tool ─ tailored just for your specific needs ─ to help you keep track of all your health care information in one place. Dr. Burns notes that a good Survivorship Care Plan should include:

  • A summary of treatment
  • A detailed plan for ongoing care
  • Follow-up schedules
  • Lists of any tests you need
  • Recommendations for how to watch for any treatment-related issues

How to use your plan

It is important to share your Survivorship Care Plan with your primary care doctor as well as any other specialists involved in your after-transplant care. This will help everyone communicate with each other.

Take your Survivorship Care Plan with you to all your visits with doctors and nurses. Use it as a reminder to ask questions, take notes, keep track of test results, and write down the next steps. “Transplant recipients have told us that having a plan helps relieve their worry that something won’t get done that’s important to help them stay healthy,” says Dr. Burns.

A recent research study of more than 450 transplant recipients showed this to be true. In this study, half the recipients received a personalized care plan, and half didn’t. Everyone in the study was 1-5 years past their transplant, and those who had a personalized care plan reported significantly less stress related to their cancer treatment.

“We strongly feel that empowering patients with knowledge and information will facilitate their survivorship care,” says Navneet Majhail, M.D., M.S., leader of the research study and director of the Blood and Marrow Transplant Program at the Cleveland Clinic Taussig Cancer Center.

Share your plan

Caregivers are important members of each transplant recipient’s support team. Parent caregivers can use the Survivorship Care Plan to keep track of their child’s health care needs, which will change as their child grows up and becomes an adult.

Dr. Burns also encourages adult transplant recipients to share their plan with caregivers and family members. It’s important for them to know what steps are needed to help their loved one stay healthy. “Caregivers and family members can help you coordinate visits and tests, remind you of questions to ask your care team, and may even notice symptoms that you haven’t. So it’s best to keep your support team informed.”

If you don’t have a Survivorship Care Plan

Your doctor or care team should give you a plan when you finish your transplant. If you’ve finished treatment but don’t have a Survivorship Care Plan, ask your transplant doctor or care team for one. Be sure to ask your doctor about anything in your Survivorship Care Plan that you don’t understand.

And if your transplant was several years ago, your care plan may need updating. That’s because transplant doctors know more than they did in the past about caring for transplant recipients, explains Dr. Burns. Plus, she notes, medical guidelines for follow-up care have changed with time. “Take your care plan to your appointments and ask them to review and update it so it meets your current needs.”

How Be The Match can help

You can also use free after-transplant care guides from Be The Match® to help keep your recovery on track. The guidelines have information on the recommended tests and exams for your 6 month and yearly checkups after transplant.

The guidelines are available in a free mobile app, online or print. There’s a version for your health care team, too. Bring a copy of your care guide with you to your next BMT appointment.

Super Star Advocate: Becky Tombleson

Posted February 20th, 2018 by Be The Match and filed in Volunteer Stories
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“Advocacy and policy is daunting, but not impossible and I’m buoyed by the sense that I can make a lasting impact in laws and policies that effect patients and their access to care.”

Becky, legislative advocate

Becky Tombleson is a clinical pharmacist with over eight years of experience at Moffitt Cancer Center in Florida and has worked in the Blood and Marrow Transplantation program for most of those. Becky got involved with the National Marrow Donor Program® (NMDP)/Be The Match® because, “as the years go by, one thing remains critical to my patients and their outcomes: access to care. That care takes on many shapes as a prescription that gets denied or a transplant that gets delayed. I have become passionate about access to care watching our patients struggle with financial burdens that complicate their lives and inhibit their outcomes. Our patients are fortunate to have vocal advocates and allies in NMDP and Be The Match.”

Last year Becky traveled with the American Society of Blood and Marrow Transplantation (ASBMT) and the NMDP in an effort to garner support from our lawmakers in Washington for the Protect Access to Cellular Transplant (PACT) Act, HR 4215. When asked about her experience and advice for new advocates, she said, “at first, I was very intimidated! I like to follow policy in Washington closely and as much as I tried to calm myself down, our lawmakers still seem like celebrities to me. Once I was able to visit with a few, I realized I was able to play an important role in their education and how much of an impact that makes on our patients. Our lawmakers are very educated in a number of ways but lack the insight I have as a clinical pharmacist – I found them grateful to learn of the impact access to care has on our patient’s lives.”

Becky is passionate about policy change because, “as time has progressed, I see advocacy and policy as a way to reach out beyond my institution, to patients I will never meet, and hopefully make the process an easier one for them. There are so many ways to impact patient care and I think my focuses have just gone a bit broader than before.”

Many people have never met a lawmaker before, but don’t worry because Becky has great advice. “Think through what you want to say and what is likely to leave a lawmaker with the clearest sense of what you do, what the patient need is, and how the legislation you’re discussing can make that a reality. Our lawmakers care about the interests of their constituents and want ultimately, something that will be beneficial to their lives. Our lawmakers are also involved in many different initiatives and bone marrow transplant is a complicated issue that many people don’t understand that lack experience with it. Also, try to stay calm if you’re easily dazzled by some lawmakers like I was!”

Becky also took the time to get others involved. “I was very fortunate to collaborate at Moffitt Cancer Center with our Federal Legislative Affairs Director. We were able to discuss in detail the PACT Act and how it could not only benefit our patients, but others as well. We both agreed that our institution sets a high standard in caring for patients that depend on access to transplant and that should be communicated to our lawmakers. We were thrilled to see the support we had and the impact that has had on the PACT Act. As one of the most nationally renowned cancer centers in America, we knew a letter of support or call could make all the difference.” And it did. Within a week Becky and her efforts added two co-sponsors!

You too can be a super star like Becky! If you want more information on how you can be a volunteer leader and super advocate, email Jess Knutson.

Volunteer Spotlight: Tom Teach

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Tom Teach’s commitment to Be The Match® started when his 4-year old grandson, Ben, was diagnosed with ALL and AML. Ben received a bone marrow transplant and for nearly six beautiful months after, Ben laughed and smiled as a cancer-free little boy. But when Ben’s leukemia returned, nothing could be done. Tom and his family said goodbye to their sweet boy in February 2015.

Today, Tom is a dedicated member of the Foundation’s board and a passionate champion of Be The Match. Tom is a Navy veteran and he and his son spoke at the Naval Academy and with the help of the Department of Defense, recruited more than 700 potential donors to the Be The Match Registry®. Tom continues to participate in leadership roles at registry drives at the Naval Academy. As a Notre Dame alum, he utilizes his contacts to raise awareness and help recruit registry members at Notre Dame games. He has also extended his efforts to Goshen College and Bethel College.

In addition, Tom has become a tireless fundraiser for Be The Match Foundation®. He helps acquire key sponsorships for the Be The Match Walk+Run event and participates with his friends and family as “Team Ben.” Over the past three years, his team has raised more than $165,000 for the Chicago Be The Match Walk+Run.

“Tom’s service to Be The Match is an excellent example of true volunteerism,” says Nicole Kersting, Senior Development Manager at Be The Match. “In addition to his recruitment and fundraising efforts, he is willing to step in with any in-kind request large or small through his foam packaging company.”

The impact Tom continues to have on patients and their loved ones is huge. Due to Tom’s efforts, more patients are able to get a second chance at life.

Looking to get involved? Find a volunteer event near you.

Counting down the days to Super Bowl LIVE!

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Minnesota Super Bowl Host Committee Partnership 

Since June, Be The Match has partnered with the Minnesota Super Bowl Host Committee (MNSBHC), and we are thrilled to be working with this organization. This partnership is a great opportunity to celebrate our communities’ diversity while raising awareness of our life-saving mission.

Through our partnership with the MNSBHC, Be The Match is sponsoring the Business Connect program, the NFL’s supplier diversity program to develop and utilize Minnesota-based, minority-, women-, LGBT- and veteran-owned businesses.

Additionally, Be The Match is sponsoring Crew 52, the group of 10,000 volunteers who will be welcoming guests into our beautiful city of Minneapolis, during the Super Bowl LIVE event.

Super Bowl LIVE

Come visit Be The Match at Super Bowl Live! This epic 10-day fan festival will take place on Nicollet Mall in downtown Minneapolis from January 26th – February 4th. The event is free and open to the public and will feature live concerts, national broadcasts, food and fun. The theme, “Bold North,” will showcase Minnesota winter, celebrating humor, hospitality and the heroic spirit.

The Be The Match Activation Zone, will be located on Nicolette Ave., between 10th and 11th street. Fully enclosed and heated, the activation space will provide attendees the opportunity to experience what it means to literally save a life. Throughout the 10 days, Be The Match Interactive Zone, will feature special guests, games and giveaways! 

Don’t miss this once-in-a-lifetime opportunity to be part of the world-class fun and excitement!

Little Emilie!

Posted January 16th, 2018 by Be The Match and filed in Patient Stories
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Little Emilie!

At 9 months old, Emilie Meza was diagnosed with acute myeloid leukemia and her family was told that her best hope for a cure would be a marrow transplant. She is now 1 year old, and has not found a match on Be The Match Registry®. After searching for a marrow match, her doctors and family made the tough decision for her to receive a haploidentical marrow transplant from her father, Eduardo Meza. A haploidentical transplant comes with extra precautions, as this means he was a half-match to Emilie, not a full match. While recent outcomes of haploidentical transplant are promising, many marrow transplant doctors prefer a fully matched adult marrow donor over a haploidentical marrow donor. But this was the best option available for Emilie.

Emilie’s family continues to encourage others to join the registry and support Be The Match® so that other families don’t need to make the tough decisions they have regarding alternative treatment options. Emilie received her marrow transplant from her father, and is now continuing to recover with her family and doctors by her side. You can get frequent updates on her recovery from their facebook page, Emily Meza’s Bone Marrow Transplant Journey.

Please consider signing up for a monthly financial gift to help patients like Emilie find a fully matched donor on Be The Match Registry. Your financial support helps add more potential marrow donors to the registry, fund advancements in marrow transplant science and provide relief to patients and families facing financial barriers to treatment.

Give today!

 

Meet Lorayne, Peer Connect volunteer

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Lorayne, transplant recipient and Peer Connect volunteer with her grandchildren

Lorayne was diagnosed with acute myeloid leukemia (AML) in October 2011, and 5 months later received a transplant from a donor in Germany.

She remembers how bewildering it was to get her diagnosis and how hard it was for her to process all the complexities of getting a transplant.

So she was grateful that her transplant team didn’t just focus on her medical and physical needs, but also helped her connect with someone who had been through the transplant process. That person was Wendy, a Peer Connect volunteer, who helped Lorayne address her fears and anxieties about transplant.

And now Lorayne wants to give back and help others going through the transplant process. She has been a Peer Connect volunteer for about 4 years now.

“Everyone’s journey is difficult,” she says. “I feel like they want to know that they can do this.”

 

Forming special bonds

Be The Match started its free Peer Connect program because transplant patients and caregivers reported that they benefited a great deal from talking with someone who’s “been there” and “gets it.”

“A lot of people just need to talk,” Lorayne says. “I understand what they’re going through. I had all those fears and worries, too.”

Lorayne, now a grandmother of 7 and 5-year-old grandsons and a 2-year-old granddaughter, was a kindergarten teacher. Because of her profession, she says that she knows how to be an active listener, which she says is critical to transplant patients and caregivers. “As a teacher, I think I have the temperament,” she says. “I’m encouraging and empathetic.”

Some people have frustrations with their family or their medical center, she says. One way Lorayne helps people is by giving them a chance to verbalize those frustrations, which allows them to unburden themselves.

“My experience as a volunteer is that people are so ready to talk ─ and need to talk,” Lorayne says. “They want information, they want their fears and anxieties addressed, and they want reassurance.”

Part of that reassurance for patients and caregivers is simply talking to someone who has successfully gone through the transplant process, says Lorayne. “I think back to my experience talking with Wendy. She got through it and she was alive. People want to know there is life after transplant.”

 

What to expect from the Peer Connect program

The Peer Connect program matches volunteers with patients or caregivers based on the request. Some people want to talk to someone who is close to their age. Other people may want to connect with someone who has the same disease or other life circumstance.

In one instance, Lorayne connected with someone who had the same type of graft-versus-host disease (GVHD) that Lorayne did. Talking with another person who also had to deal with GVHD of the liver helped that patient a lot, Lorayne says, but the connection was also a learning experience for Lorayne and their connection gave comfort to both of them.

Lorayne’s approach when assigned a Peer Connect patient is to email the person first, to arrange a convenient time to talk on the phone. The first call can be as long as needed, Lorayne says, and begins with Lorayne asking about their experiences and their current situation.

“As they’re able to talk, I’m able to share my experience with them,” Lorayne says. “They can expect a listening ear, a comforting volunteer, who will be there for them even beyond a phone call.”

Typically, Lorayne and her connections will talk again or connect by email a few more times. “As volunteers, we’re always there for follow up,” Lorayne says.

Request a connection

If you’re struggling with your transplant recovery, you are not alone. No matter where you are in the transplant process and recovery, and whether you’re a transplant recipient or caregiver, our Peer Connect program can connect you with a trained volunteer who’s been there.

Visit BeTheMatch.org/peerconnect to request to talk with a Peer Connect volunteer.

Or:

When caring for a transplant patient, take care of yourself, too

Posted January 7th, 2018 by Be The Match and filed in News
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Justin, transplant recipient, with mom and caregiver, Kari

If you are a transplant recipient, please share this article with your caregivers.

Researchers know that transplant caregivers are affected physically, emotionally, socially and spiritually by the transplant process and recovery. But caregivers may be thinking about all they have to do, and not thinking of taking care of themselves. In this article, you’ll find tips to help cope with the many challenges that come with taking care of a loved one who is recovering from a transplant. Plus, Be The Match has many free resources, listed at the bottom of this article, that can help.

Coping with stress

The stress of recovery from transplant affects you, too. And if you become physically exhausted or emotionally overwhelmed, you won’t be able to provide the care you want to give your loved one in the months ahead.

People have different styles of coping with stress. Think about your coping techniques and how they are, or aren’t, helping you. You can do this on your own, but some caregivers find it helpful to get support from others, including professional counselors, to help them learn coping techniques that work best for them.

Here are a few things to remember to help you cope when you feel stressed:

  • It’s normal to have emotional ups and downs
  • Put first things first and let the little things go
  • It’s okay to take some time alone
  • There are people who can help
  • You do many things very well
  • Take a breath in and out

Coping with emotions

Caregiving can bring up a lot of different emotions. And some of them, like anger or guilt, might at first seem wrong, and cause a caregiver to feel ashamed. But it’s important for you to know that all of your emotions are normal and okay. It’s how you cope with them that matters.

Here are some common emotions that caregivers sometimes experience, and some tips on handling them:

  • Feeling sad is normal. But if it lasts for more than 2 weeks, and interferes with your daily life, tell your doctor. It could be depression.
  • If you’re angry, do some self-reflection to figure out why. Knowing the cause might help you think of ways to cope.
  • Transplant has brought about a big change in your life, and it’s okay to grieve the loss of the way things were before. Grief takes time and attention to work through, and professional counseling may help you through the process.
  • No matter how dedicated you are, you might feel guilty that you’re not able to do more. Or, you might even feel guilty if you focus on your own needs. Remember, nobody is perfect and you do many things well. Caring for yourself is as important as caring for your loved one.
  • You might feel alone if friends and family have stopped visiting, or if you think no one understands your situation. Sharing your feelings with someone you trust may help you feel less lonely.

You have your own path to recovery

Because you are focusing so much on your loved one, you might not notice your own stress.

It’s important for you to pay attention to your own health and well-being because severe or chronic stress can cause depression, problems with memory and concentration, tiredness, and other issues if left untreated.

One caregiver put it this way: “I wasn’t really interested in any of the things I used to do. I was so busy trying to make it through each day that I never noticed that I had changed. My doctor explained that I was depressed and overwhelmed ─ and he prescribed anti-depression medicine (which helped). Both my daughters said they were happy to hear me laugh again.”

Sometimes it can help to talk with someone who’s been where you are and gets it. The Be The Match Peer Connect program connects you with a trained volunteer who is also a transplant caregiver. These volunteers can answer your questions and share their own experiences. Visit the website to learn more and request a Peer Connect connection.

Getting help from others

Everyone needs support when they are going through a difficult time. It’s okay to ask for and accept help. Remember, you would want to help your family and friends if they were in your situation.

Reach out to family and friends and let them know that you still need their help once you’ve left the hospital and returned home. General requests such as “Could you watch the kids sometime?” likely won’t help. Instead, ask for something specific such as “Next week we have several appointments. Could you watch the kids next Friday afternoon from 2 to 4?”  If you don’t live close to family or friends, consider asking neighbors, faith community members or co-workers for support.

Also, keep a list of specific tasks you need help with, like:

  • Meals
  • Childcare
  • Transportation
  • Yard work
  • Housework
  • Grocery shopping

Post the list in your home where people can see it, but more important, share it with friends, family, coworkers, or any other potential source of support.  If you use social media or other online support forums, such as Caring Bridge, consider making requests for help there.

Support for caregivers at every step

Remember, you’re not alone. Help is available. Contact the BMT Patient Navigators through the Be The Match Patient Support Center. They can help you get reliable, easy-to-understand information from diagnosis through recovery. They can also help you access one-on-one support through our:

Call or email us to learn about the many other ways we can support you through confidential, one-on-one support from caring experts. We’ll listen and help you find answers. All of our programs and resources are free.

CALL: 1 (888) 999-6743 Monday through Friday, 8 a.m. – 5 p.m. Central Time

EMAIL: patientinfo@nmdp.org

LEARN MORE: BeTheMatch.org/patient

ORDER RESOURCE MATERIALS: BeTheMatch.org/request

Volunteer Spotlight: Marcia Diefendorff

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Marcia Diefendorff first decided to get involved with Be The Match® when a family friend was fighting for their life and needed a bone marrow transplant in order to survive. She reached out and asked how she could help after learning about the marrow donation process and the great need for more donors to join the Be The Match Registry®.

Marcia began volunteering at local events throughout the Peninsula and South Bay Area in California where she educated people about Be The Match, the need for new registry members, and the importance of saving lives. It quickly became clear how talented Marcia was at teaching and interacting with people, which is no coincidence as she had been a teacher for many years.

Not only did Marcia volunteer around the time of her friend’s transplant, but she continues to stay extremely involved. You can still find Marcia at events two to four times a month and even up to four to five times a week during the busy season! Her dedication and generosity has not gone un-noticed. Marcia now trains other volunteers about the registration process, runs her own events, and continues to make meaningful connections with everyone she encounters.

“She improves every event she attends and is one of the most genuinely kind people I know. When I’ve called to thank her she usually says that she appreciates the call, but doesn’t do it for the thanks you’s,” says Amber, friend and former Be The Match Community Engagement Representative.

Marcia has made a huge impact already and continues to by volunteering for Be The Match. She has added many new potential donors to the registry, which provides patients with more hope and a chance at finding their life-saving match. Marcia’s dedication and years of service has earned her the Daily Point of Light Award as well as the title, Volunteer Ambassador of Be The Match.

If you’re a proud Be The Match volunteer like Marcia, share your support on social media with one of our volunteer badges.

Protect access to transplant for patients like Mark

Posted December 4th, 2017 by Be The Match and filed in Patient Stories
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Mark, transplant recipient, with his wife

In 2008, after feeling tired constantly and experiencing night sweats, Mark knew these symptoms were a red flag and visited his doctor. Blood tests revealed his counts were dramatically low – which indicated lymphoma. Additional tests revealed that Mark had mantle cell lymphoma, a very rare form of lymphoma that is classified as incurable. A bone marrow transplant would be Mark’s best hope of keeping his disease in remission.

Mark started six rounds of chemotherapy to go into remission while his doctors at the University of Michigan searched the Be The Match Registry® to find him a match. He had five perfect matches. Mark’s second perfect match stepped up to be his life-saving donor. Throughout his transplant journey, Mark said he felt fortunate to be able to focus on recovery and healing instead of worrying about his insurance coverage.

The cost of transplant can be up to $200,000. And most often, transplant centers are only reimbursed approximately $65,000 to treat Medicare patients. This creates an access barrier for patients to receive the life-saving treatment they need.

“Lymphoma can come back,” he said. “I visit patients who are in their 70’s and getting transplants. I have seen the bills without insurance – without Medicare coverage, people could not do it.”

Please urge your Members of Congress to co-sponsor this upcoming legislation. Medicare beneficiaries like Mark and the patients he volunteers with need your help: be the voice to save a life.

Feeling thankful during a difficult transplant recovery

Posted November 6th, 2017 by Be The Match and filed in Patient Stories
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It’s not unusual for people to feel thankful to be alive after overcoming a life-threatening illness. But being thankful after a blood or marrow transplant (BMT) can be difficult if you are also coping

David, transplant recipient, with his sister and parents

with negative physical, emotional and financial issues after a transplant.

Read on to get expert advice from a BMT Social Worker on how you and your loved ones can feel more thankful even in difficult times.

The following are excerpts from an interview with Olivia Eusden, MSW, LICSW, BMT Social Worker, Patient Support Center, Be The Match®.

Is thankfulness possible for people who have serious complications or challenges after BMT?

Olivia: Feeling grateful can seem nearly impossible when you have serious complications or challenges after BMT. Thankfulness is possible, it just may look different from before. For protective reasons, we often resist the pain caused by serious life challenges. But, if we surrender to the pain, it’s possible to feel hope that things will get better someday – and if not better, easier.

Recognizing even small feelings of hopefulness can allow you to move out of the victim space and into the “survivor” role. As a survivor, you might find that you take nothing for granted. You also might find that BMT gave you more perspective, brought you closer to others, afforded you more patience, or made you more empathetic. Perhaps you’re more resilient and open to new experiences than you once were. All of these changes you notice about yourself after transplant are reasons for gratitude.

 

What are some ways people can cope with ongoing challenges after BMT?

Olivia: Ongoing challenges after BMT can feel defeating. You might feel isolated in your grief and pain. It’s important to remember that you aren’t going through this alone.

If it feels like others in your support system “don’t get it,” try connecting to a community of people who share your experiences. Find a support group through your transplant center, or register for Be The Match Survivorship Chats.

Support groups are safe spaces to share your fears and frustrations without feeling judged or misunderstood. It can also be a place for you and other patients to share what you’ve learned, suggest creative solutions to common problems, and provide emotional support. Participants in a support group may understand what you’re experiencing in ways that other people might not.

 

What advice do you have for someone struggling to feel thankful after BMT?

Olivia: If you’re struggling to feel thankful after BMT, try to redefine “gratitude.” At another time in your life, showing gratitude might have felt important in situations such as receiving birthday presents, or when someone cooked you a meal.

Now, in more challenging times, appreciation and gratitude happens on an entirely different level. Gratitude might look like thankfulness for breath and vitality, or an appreciation for waking up in the morning and going to bed at night.

Some patients share that instead of wishing their experience with BMT away, they learned to take illness/recovery as an opportunity to slow down, regroup, and listen to what was going on for them personally. In that sense, illness became a tool for personal growth and discovery that may not have occurred otherwise.

 

What advice do you have for someone feeling pressured to express thankfulness after BMT?

Olivia: With Thanksgiving in view, the cultural nod to thankfulness is blatant. If you receive or feel pressure around the holidays to express thankfulness, recognize that you may not be in a place where gratitude feels possible right now.

Gratitude is personal and will vary from person to person based on past experiences, personality and circumstances. Give yourself permission, or ask for permission from a close family member or friend, to feel less-than-grateful at this time.

No matter where you are in your survivorship, if you’re feeling like your thankfulness is lackluster, it can be meaningful to spend just one moment each day listening to what your body is telling you without judgment. Notice something you weren’t aware of before, and explore the possibility of carving out a tiny space for gratitude just for having this daily ritual.

One day, you will be able to find a bit of gratitude and it may make all the difference.

___________________________________________________________

The Be The Match Patient Support Center provides support, information and resources for transplant patients, caregivers and families.

Contact us using the information below to register for a Survivorship Chat, talk to another BMT recipient or caregiver through the Peer Connect program, or get one-on-one telephone counseling support from a licensed clinical social worker. All services are free.