It was the end of Julie Silver’s breast cancer treatment. The 38-year-old Boston rehabilitation doctor was free to go back to her career, and continue raising her three small children, and yet, rather than feeling better, she felt sicker than she ever had in her life.“Unfortunately, this is true with most cancer treatments,” Dr Silver said. She is the author of ‘After Cancer Treatment: Heal Faster, Better, Stronger’ and ‘What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope’. She was in Bermuda on Saturday to give several lectures for the Bermuda Cancer & Health Centre.“If you had a car accident or a stroke, your doctor would never say ‘go home and figure out how to heal’,” said Dr Silver. “They would offer you rehabilitation. With cancer it doesn’t happen that way. You get sicker and sicker and when you are sicker than you have ever been that is when you are discharged and followed up intermittently. Very little has been written about that or talked about with patients. There is a new trend towards survivorship care, but still patients don’t realise there is a lot more that can be done to help them after their last radiation or chemotherapy treatment.”Dr Silver is an assistant professor at Harvard Medical School in Boston and is also chief medical officer for Oncology Rehab Partners in Boston. Although she returned to work less than a year after finishing treatment, it was probably three years before she felt completely healed and able to handle all facets of her work.“The real message I want to get across is what it takes to heal after treatment,” she said. “So much has been written on the actual diagnosis but there is not very much of a focus on how you survive cancer, reclaim your life and physically start feeling better. One of the things about cancer is that people often feel much better at the beginning of treatment than they do at the end.”Dr Silver said the experience changed her, and also changed her career. She now focuses more on the rehabilitation of cancer patients including breast cancer patients. The motto on her Oncology Rehab Partners business card is ‘Survivorship Training and Rehab’.She was just 38 years old when she found something in her breast during a self-examination. The trouble was she couldn’t say exactly what she had found. It wasn’t a lump, but more like a feeling that something was wrong. She went to her regular doctor and had a mammogram. Nothing was found.She got a second opinion.“That is what I always tell my patients to do,” she said. “If you don’t feel like your doctor is listening, then get a second opinion. I felt like the second doctor really listened to me.”This doctor was more sympathetic, but the second mammogram still didn’t find anything. Dr Silver persisted. This doctor agreed to a third mammogram and it was only then that the mammogram revealed a problem. She was diagnosed with breast cancer.“People ask me how I knew something was wrong,” she said. “I don’t have a great answer for that. I think that people tend to know their bodies really well and they have a sense sometimes when something is not right. Intuition about your body is such a great and powerful thing to listen to. I did have people telling me I was a little bit of a hypochondriac. I would have rather been a hypochondriac than be diagnosed with cancer. In fact, I wasn’t a hypochondriac, I had a very serious life-threatening illness.”Today, she doesn’t like to focus on her diagnosis and treatment so much. In fact, talking about the whole experience is still painful.“Even now talking about my own experience can be really difficult,” said Dr Silver. “But I talk about it, because I want to let people know how hard it was to be young, and presumably healthy and then diagnosed with a life-threatening illness, undergo treatment, and then when I was sicker and more frail than I had ever been in my life, to be told that it was time to go back to work. At the time I had three little kids at home. I really couldn’t go back to work. It was very difficult. I wanted more care with that part of my cancer care than I received.”The experience was naturally hard for her children also. They have written two books about it for the American Cancer Society ‘Our Mom is Getting Better’ and ‘Our Dad is Getting Better’.Dr Silver said too often cancer survivors are referred to psychological treatment, but not other forms of rehabilitation such as physical therapy or occupational and speech therapy.“If someone had a stroke would you say, ‘here go see the psychologist’, or would you send them for occupational and speech therapy and all the things that help them recover?” she asked. “Of course, psychological counseling would be part of that, but it wouldn’t be the only part. That is what cancer survivors are told all the time. They are referred to mental health consultation and not offered physical health consultation and both are important.“Surgical treatments for most cancers, but certainly breast cancer, are very difficult to recover from frequently. Then you combine that with other treatments such as chemotherapy and radiation and you are getting three really toxic treatments all in a row.”She wants to see rehabilitation medicine made a part of the cancer care continuum, so that when someone has physical problems such as pain or balance and gait problems or they are very tired or they are not as strong as they use to be, they are referred for physician consultations.Her other message for cancer patients is it is never too late to hope.“Almost everyone who is diagnosed with cancer is not diagnosed with cancer at the earliest possible stage,” she said. “Yet, there are 12 million cancer survivors in the United States. If you have been diagnosed with cancer and it wasn’t the earliest possible stage, you are in a similar situation to many people who have survived cancer. So be hopeful. Trust your doctors. Get good advice and focus on healing.”Useful website: www.juliesilvermd.com, www.cancer.bm, www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection.For information telephone the Bermuda Cancer and Health Centre on 236-1001.