Dealing With Grief

Risk Factors

Medical research has not identified what causes complicated grief or who may be more susceptible. However, there are some established situations where a person is more likely to develop prolonged grief. These include:

• An unexpected or especially violent death
• Lack of a support system – either family or close friends
• Suicide of a loved one
• Childhood separation from parents or loved ones
• Dependent relationship with the deceased loved one
• History of childhood abuse or neglect
• Being unprepared for the loss
• Experiencing multiple losses within a short period of time

These factors may indicate a situation where prolonged grief can occur. However, some people will not experience prolonged grief even when they are exposed to one or more of these situations. The best way to diagnose complicated grief is to carefully monitor your loved one and make sure that the symptoms of grief subside over time.

Symptoms

As mentioned previously, the initial symptoms of complicated grief are similar to those of normal grief. For the first few months, normal grief and complicated grief are often indistinguishable. The difference occurs because the symptoms of normal grief begin to disappear over time while the signs of complicated often linger or worsen.

Other signs of chronic grief include:

• Obsessive focus on the loss or on reminders of the lost loved one
• Intense yearning for the deceased
• Numbness or detachment from the outside world or from inner emotions
• Preoccupation with personal grief
• Bitterness or anger
• Inability to find pleasure in life
• Depression
• Inability to carry out normal routines
• Lack of trust in others
• No motivation to attend social events
• Feeling that life has no meaning or purpose

Pre - Bereavement Care and Thoughts

It’s tragically common for patients to ignore warnings of other types of cancer, adds Dale Shepard, MD, PhD, a cancer specialist in the department of solid tumor oncology at the Cleveland Clinic. “Cancer can almost always be cured if it’s caught early, but all too often, people wait so long to see a doctor that the disease has spread to the point that it’s no longer curable.”

If you notice any of the following unexplained warning signs, don’t delay—make the time to consult a doctor promptly.

• Unexplained weight loss. While most people would be happy to drop pounds without dieting, unexplained weight loss (of 10 or more pounds) or sudden loss of appetite are among the most common warning signs of cancer, says Dr. Shepard. This symptom is most likely to occur with cancers of the pancreas, stomach, esophagus or lung, reports the American Cancer Society (ACS). It may turn out not to be cancer—there are a number of other serious health conditions that may cause this symptom, including an overactive thyroid, diabetes, liver disease, and depression.

• Persistent low-grade fever. This can be the first symptom of certain cancers, particularly leukemia, Hodgkin’s disease or non-Hodgkin’s lymphoma. Low-grade fever—meaning a temperature between 99.8 and 100.8—can also be caused by a wide range of infections. 

• Worsening fatigue. “If you suddenly can’t get through the day without taking a 3-or 4-four nap, when you never need one before, that can be suggestive of cancer,” says Dr. Shepard. According to the ACS report, this symptom is particularly likely to occur with leukemia, as well as cancers that cause blood loss, such as colon cancer or stomach cancer. Other medical conditions that cause profound exhaustion include anemia, sleep disorders, heart problems, diabetes, fibromyalgia, and arthritis.

• A sore that doesn’t heal or skin changes. You probably know that moles that are asymmetrical (one half doesn’t match the other), have irregular borders, contain a variety of colors, or are larger than a pencil eraser can bewarning signs of melanoma, the deadliest form of skin cancer. What’s not well known, however, is that skin sores or changes (including a persistent rash) can also herald other forms of cancer. Dr. Shepard had a patient whose first symptom of colon cancer was a sore on his scalp that didn’t heal. He has also had patients with lung cancer and lymphoma whose symptoms included persistent rashes.

What Does Skin Cancer Look Like?

• Trouble swallowing or chronic hoarseness. These symptoms, along with lip sores that don’t heal, unusual bleeding, pain or numbness in the mouth, and chronic sore throat, can herald oral cancer. Other reasons for chronic hoarseness can include gastroesophageal reflux disease (GERD), allergies, cancer of the throat or laryngx, smoking, and underactive thyroid, reports the National Institute of Health. A wide range of esophageal disorders can impair swallowing.

• White patches in your mouth. Also known as leukoplakia, these thickened whitish or gray patches on the gums, inside of the cheeks, or the tongue are often mistaken for thrush (an infection that causes white patches). Unlike thrush, which can be scraped away, leukoplakia cannot be removed in this manner. While the condition isn’t always harmful, oral cancer often occurs near leukoplakia patches, the Mayo Clinic reports, and the patches themselves can develop cancerous changes.

• Blood in the toilet. This symptom is frequently dismissed by patients, says Dr. Shepard. “People are quick to think that the problem is a urinary tract infection even if they’ve never had one before. However, blood in the urine can also be a sign of bladder cancer and needs to be investigated by a urologist. Oftentimes, bladder cancer isn’t diagnosed until it reaches an incurable stage because people wait so long to see a doctor.” Similarly, it can be a dangerous mistake to dismiss blood in the stool as being triggered by a hemorrhoid, since it could also be a warning sign of colon cancer, as is any change in your normal bowel habits.

• Unexplained pain. This can be an early symptom of testicular or bone cancer. A headache that doesn’t get better with treatment, such as taking an over-the-counter pain reliever, may signal a brain tumor, while back pain can mark colon or ovarian cancer, the ACS reports. “Unexplained pain is one of the more common symptoms of cancer and always warrants a consultation with your doctor,” says Dr. Shepard.

• A lump or thickening. Several types of cancer, including those of the breast, testicles, and lymph nodes can be felt through the skin. A lump or thickening can either be an early or late sign of cancer, ACS reports. Also be aware that in some cases, breast cancer can cause red or thickened skin, rather than the expected lump, so any change in how your breast looks or feels needs to be checked out. 

• Any persistent, unexplained or troubling symptom. “If something doesn’t seem right, don’t assume it’s nothing,” says Dr. Shepard. ”Listening to your body and getting this symptom checked out sooner rather than later could save your life if the problem turns out to be cancer.”

Prevention

Loneliness can hit at almost any time. When Amity Brown separated from her husband of 11 years, for instance, she felt -- understandably --  isolated and sad. "The hardest thing is not having someone with that deep emotional knowledge of me to catch me when I fall," says the 41-year-old photographer based in Oakland, Calif.

It's almost inevitable that losing a spouse or moving to a new town can make you feel lonely; but loneliness can strike even without major life changes. You can be alone without being lonely, or you can feel lonely in a crowd. True loneliness is simply a feeling of being disconnected from others; 5% to 7% of middle-aged and older adults report feeling intense or persistent loneliness.

Recommended Related to Mind, Body, Spirit

By Ellen Welty Yes, you love the woman, but her constant commentary on your haircut, housekeeping, and more is making you nuts. To get her to back off, read on.

"Loneliness is what you say it is. You can't tell somebody you shouldn't be lonely," says Louise Hawkley, PhD, senior research scientist with the Center for Cognitive and Social Neuroscience at the University of Chicago.

Loneliness and Illness

Loneliness is not only emotionally painful; it can harm your health. It's a risk factor for a host of problems: high blood pressure; sleep problems; decreased ability to deal with the stress of daily life; and the body's reduced ability to handle inflammation, leading to conditions such as atherosclerosis, rheumatoid arthritis, and tendinitis, as well as a weakened immune system, so you're more susceptible to illness. Researchers have yet to identify the exact ways these health problems occur, but they know that loneliness seems to make them worse.

While many of these issues don't show up until middle age or later, the damage begins early, according to Hawkley. Small increases in stress chemicals released into the bloodstream can, over time, damage blood vessels all over the body.

Of course, some lonely times are inevitable in everyone's life, and you don't need to fear them. Think of loneliness as a thirst for companionship, one you can satisfy. Says Hawkley, "It's a feeling that, if it's doing its job, it gets you out there to sate that need to feel connected." 

The Loneliness Cure

Louise Hawkley, PhD, says we should think of loneliness not as a state but as a motivation to get social. Here's how:

Get out and about. You don't have to be best friends with someone to benefit from interaction. Amity Brown, who is separated from her husband, takes walks around her neighborhood, smiling at people she passes. "When I started getting to know the neighborhood and the people around me, I felt like part of a community," she says.

Be selective about making friends. Hawkley points out that if you're desperate for relationships, you may be willing to tolerate unacceptable treatment. Now that Brown is feeling more stable, she says, "I'm more careful when I choose my friends to make sure they're low-drama."

Stay positive. Lonely people tend to expect rejection, which makes it more likely to happen. Social cognitive therapy can help people reframe their thoughts about how others see them.