Mental Health Topics

Dealing with Sexual Issues For Cancer Patients

There are a wide range of thoughts and emotions that accompany a cancer
diagnosis that are completely normal. However, these thoughts and
feelings may not feel normal because you may not have felt them before.
Symptoms of depression, anxiety, sleep problems, and relationship
challenges very typically occur along with all the effects of cancer or
its treatment. However, discussions about sex are often neglected by
health professionals and patients.

Many people are not comfortable discussing sex, especially cancer
patients who are dealing with life-changing issues and have more stressful
and life-threatening concerns on their minds.

But should the topic of sex be equally important to those with cancer?
Of course.

I have often found in my work as a mental health counselor, that couples
are very interested in learning about how to have sex comfortably and
safely during and after cancer treatment.

A cancer patient and their partner often have questions about sexual
intimacy due to a loss in the cancer sufferer’s libido (sex drive) or
negative sexual functions that can result from the cancer treatment. As
a result, they look for advice from their doctor and/or other health
care professionals to gain a better understanding of the affects of
treatment and how it affects their sex drive so they can continue to
enjoy having sex as they did before diagnosis with cancer.

The difficulty with talking about sex, falls not only upon the patient,
but upon doctors too. Many doctors will often avoid the subject or wait
for the patient to raise it. Yet, a cancer patients and their
caregivers often wants information to understand how treatment will
affect their sexual desire and function.

One study suggests, that: “Health professionals may also believe their
discussions [about sex] may be construed as disrespectful and
inappropriate by the patient, with research suggesting that gender, age,
culture, socioeconomic factors, and religion all contribute to health
professionals’ avoidance of the topic…” (Asia-Pacific Journal of
Clinical Oncology, 2009).

In my experience as a counselor, whom has provided therapy for cancer
patients, it’s easy to understand how concerns about sex may go
unattended to because both patients and physicians are unwilling to
engage in dialogue about the topic.

Raising this issue with your doctor is important because many newly
diagnosed patients and their partners may not be aware of the safety
issues involving sex, cancer, and treatment.

Whether or not your doctor raises the issue, you should be brave and
raise the issues and questions you have about cancer treatment and sex.

As a guide, here are some helpful questions in which you can ask your
doctor about sex and mesothelioma:

Do I need to take precautions during intercourse while I am on

How will treatment affect my energy levels and libido?

How soon after surgery or a procedure can I have sex?

Is it safe for me to physically exert myself during sex while I am on

Have other patients receiving the same treatment reported side effects
that impact sex?

Is oral sex safe during treatment?

How will treatment affect my hormone levels?

Will I be able to have children after I finish treatment?

How will treatment affect my fertility?

When you or a loved one are battling cancer, so many things do not feel
normal. Sometimes, sex can return some sense of normalcy. It can also
improve a couple’s quality of life during this difficult time. It may
take some courage to raise concerns and questions about sex to your
doctor, which may not be easy, but most patients find the payoff in
having discussions about sex while battling cancer is well worth the

Parenting To Prevent Suicide

As a licensed mental health professional, I’ve worked in a variety of hospital settings where I have worked with adults and teens who have tried unsuccessfully to commit suicide. The vast majority of those who survived their suicide attempt were so grateful to have survived their attempt. Almost all of them want to learn how to better cope with life so that they never reach a point that they feel so hopeless, desperate and impulsive again. In working with family members after a loved one’s suicide attempt, it has been challenging to explain how their loved one could reach such a hopeless state of mind that suicide was the only or best option.


As a mother to two teenage boys, one of my goals is to teach them how to manage life’s emotional challenges like not getting that job they really want, not making the varsity team, or the breakup of their first true love. Recently, I was assessing a teenage patient in the ICU who barely survived a very serious suicide attempt after the breakup of his first serious relationship. As I talked to him and his family, I couldn’t help but to ask myself “What if that were my son?” This particular young man had a very bright future academically, yet he felt so emotionally distraught that the only solution in his mind was to take a bottle of pills.


Throughout my years of practice, I’ve learned that when people are unable to acknowledge, understand or cope with emotional pain, anger, sadness, or grief in a healthy way that they typically turn to unhealthy ways of coping like misusing drugs or alcohol to numb their pain. Alternatively, they may engage in impulsive and dangerous behaviors including cutting and suicide. As a therapist, my work with these clients is to help them recognize, understand, and better cope with their emotional pain in a healthier way.


Emotional intelligence is a term that relates to one’s ability to recognize their own emotions, other people’s emotions, AND to manage unpleasant emotions in a healthy way. Studies show that people who have high emotional intelligence and emotional resiliency are much less likely to self harm either by cutting or attempting suicide or to misuse drugs and alcohol. When children demonstrate high emotional intelligence, they are more likely to use healthy coping skills and have healthier relationships with others. However, it is rare that our children’s school curriculum includes teaching about emotional intelligence, so it’s one of those things that we have to learn on our own.


How can parents influence their children’s emotional intelligence?

There are many things that parents can do to teach and model emotional intelligence and emotional resiliency to our children. In addition to teaching our children how to read, tie their shoes, and how to drive a stick shift, we need to also teach them about emotions. We need to show them that it’s okay to ask for help when we are struggling. We can normalize their emotions when they are sad, lonely, or down on themselves. We can be brave enough to share our own pain as children and teenagers like not getting asked to the prom. We can talk to our children as we watch news stories about people who deal with their anger or fear in an unhealthy or illegal way. We can support and encourage our children when they talk to us about something that is bothering them. We can avoid labeling or degrading those who seek counseling or psychiatric care for anxiety, depression or to simply improve their mental health. We need “walk the walk” and not just “talk the talk.” We need to model to our children healthy ways of coping with life’s stressors, challenges and heartbreaks. We need to have conversations about ways to manage stress with our children and encourage them to find their own healthy stress management skills. We need to talk with them about how to forgive ourselves if we make a mistake. We need to teach them to problem solve so that they don’t repeat mistakes. We need to talk to them about healthy relationships and what makes a relationship abusive. These types of conversations may not come as easily to some parents as conversations about their homework and chores. But, the payoff to your child is well-worth your effort.


It is normal to want to protect our children from both physical and emotional pain in life. Of course, most parents acknowledge that we cannot protect them from everything, but we can prepare them for life. We need to do more than tell our children not to cry, to just suck it up, to get over it, to forget about it, or to be strong. As parents, we need to acknowledge and talk about ALL the emotions we experience in life. We need to be human and share with our children how we learned to cope with our disappointments, break-ups/divorces, job losses, financial crises, and deaths of loved ones. When children, teens, and adults feel supported and capable of handling life’s emotional ups and downs, they are much less likely to reach a place of hopelessness, helplessness, and desperation where self-harm or suicide feels like the best option.


Survivor Guilt And Depression

Survivor guilt (sometimes incorrectly termed as, survivor’s guilt) is a term often heard in the aftermath of wars, natural disasters, or some type of traumatic event. Unfortunately, this type of guilt occurs frequently and in a variety of situations. Victims of rape or assaults can believe that they are at fault or that they could have prevented the attack. Emergency workers who are unsuccessful in trying to save a life can feel guilt that they should have done things differently or acted more quickly. When a person commits suicide, the surviving loved ones usually believe that they should have done something differently to avert the suicide. The guilt that goes along with these traumatic events can lead to depression. Survivor guilt is also common in people who develop Post Traumatic Stress Disorder (PTSD) as a result of a trauma.

Mental health counselors working with traumatized clients with depression or PTSD begin by helping them sort their emotions out.  Often times, these clients don’t even recognize the presence of survivor guilt until it is pointed out by a skilled professional.  The guilt that results from the traumatic event or events can leave clients feeling like the event was their fault, or that something could have been done to prevent it.

These feelings of guilt become associated with a perception of some type of wrongdoing. Most times, being able to talk about the experience and gain a better understanding of the trauma itself with a mental health therapist can help people move towards a healthier realization that the event was not their fault, or that there was nothing they could have done to prevent it.

Unresolved feelings of guilt can intensify and create deeper feelings of hopelessness, negative self-worth and self-esteem, which further exacerbate depression. This guilt can intensify during times of stress and can have a negative impact upon relationships and work.

The most difficult part of overcoming guilt after recognizing it, is letting go of the guilt and accepting that there was nothing they could have done differently to have changed the outcome.  A counselor can aid in helping one recognize this fact and help the individual work through the issues of self-blame. It is not always an easy journey, and may raise some emotions that one may have spent many years avoiding, but talking about it with a licensed mental health counselor can be an important first step towards alleviating the guilt and depression that one may be suffering from.

It is important to remember that survivor guilt is not experienced by everyone or to the same levels of intensity. It will be different for each individual. However, when guilt and depression begin to interfere with the normal functions of daily life, it may be time to seek the assistance of a counselor.

It is important to find a counselor with whom you feel comfortable sharing your thoughts and feelings AND who has the necessary expertise to help you reach your goals. For that reason, we offer a free brief phone consultation to ensure that we are the right fit for you. If you are feeling depressed, have feelings of guilt, or would like to discuss some other issue(s), please don’t hesitate to contact Dana Nolan at 407-340-2474.

Our office is conveniently located in Altamonte Springs, just north of Orlando.

April is Child Abuse Prevention Month–Child Abuse Awareness


From the desk of Dana Nolan, Licensed Mental Health Counselor…

April is Child Abuse Prevention month.  In my practice, I have way too many clients who suffered childhood abuse and/or neglect and now have ongoing emotional or psychological issues related to trust, self-esteem, depression, anxiety/PTSD and unhealthy relationships. My job as a therapist is to help survivors of childhood abuse work through the abuse to become happy, well-adjusted adults. Ideally, it is always better to prevent a problem than to try and fix it later on.

Florida Governor Scott recently approved laws aimed at reducing childhood abuse. Today, anyone who fails to report incidents of child abuse, neglect or exploitation can be charged with a felony. Previously, only “mandated” reporters (doctors, nurses, mental health professionals and teachers) were obligated to report known or suspected abuse of a child or vulnerable adult. The purpose of this law was to make EVERYONE responsible for reporting abuse. Historically, child abuse was considered a private, family matter and many adults failed to report abuse they observed or suspected because they believed it was “none of my business.” This new Florida law means that it is EVERYONE’S business to look out for our youth and vulnerable adults.

It is really quite easy to make a report to the Department of Children and Families services here in Florida. You simply call 1-800-96-ABUSE (1-800-962-2873) or log onto It is important to have specific information ready to provide in making the report: Name, date of birth (or approximate,) race, gender, address or location of child and what exactly you observed that leads you to believe that a child is being abused, neglected or exploited. All reports to DCF are confidential and you cannot be held liable for making a report provided it is made in good faith.

Most of my clients who suffered childhood abuse or neglect have said they always wondered why no one ever stuck up for them or reported the abuse when it was observed. Please know that you CAN make a difference in the life of a abused or neglected child by being that ONE person who does stick up for them and makes that phone call to make a report.

Dana Nolan– 2013 Healthcare Volunteer of the Year Award


The Leukemia and Lymphoma  Society presented Dana with the 2013 Healthcare Volunteer of the Year Award.  The Leukemia & Lymphoma Society (LLS) is the world’s largest voluntary health agency dedicated to blood cancer.  They fund blood cancer research around the world.  Their mission is to improve the quality of life for patients and their families who suffer from leukemia, lymphoma, Hodgkin’s disease and Myeloma.  Dana, a licensed mental health counselor, who specializes in counseling for cancer patients and other patients with serious illness provides patient and family education programs to the LLS.  She is honored to receive such a special thanks from a great organization.

Romance throughout the Year….Valentine’s Day

Valentine’s Day is upon us again! It is that time of year where we declare (or re-declare) our love for that special someone in our life. Greeting card companies, florists and jewelers would like you to believe that buying their products for your loved one is the best way to show your love. The bigger the gift, the deeper the love, right?

I am not “anti” flowers, jewelry or candy at all. (Note to my husband: I do appreciate any and all cards and flowers you give me!) But, my experience in couples counseling has shown me that there are many other ways that we can demonstrate our love (which includes respect, affection and appreciation) to our sweetheart. Doing little things every day is what keeps relationships strong:

*Listening to your loved one vent about their day (WITHOUT trying to fix it!)

*Buying them their favorite drink or snack without asking

*Saying “Thank you”

*Giving hugs/kisses for no apparent reason

All these are not ‘over the top’ romantic things. But, I’ve found that truly happy couples routinely do any number of little things on a regular basis to let their sweetheart know that they are loved, listened to and respected.

I am not advocating a boycott of celebrating Valentine’s Day at all! But, I am encouraging you do little things for your partner to spread the love you feel throughout the other 364 days of the year.


Dana Nolan

Licensed Mental Health Counselor

Finding Success with Your New Year’s Resolutions

Many people use this time of year to get a “fresh start” and make some changes in their lives. Most of the time these changes involve self-improvement like losing weight, exercising more, quitting smoking or addressing an emotional or relationship problem that has been worrisome. It is natural to use the ending of one year and the beginning of another to reflect on our lives, where we are headed and where we have been.This self-reflection can be a very insightful and positive exercise.

Regardless of what kind of change you may want to make, it is important to have realistic expectations of ourselves and to have a plan of action. When we are motivated to make a change, we are pumped up and want our excitement to translate into quick results! Unfortunately, this just does not happen as our habits are formed slowly, weight is put on over months and years, emotional and relationship problems evolve over time. But, DO NOT GET DISCOURAGED and stop your efforts to feel better and live better if you don’t see or feel results within a few days!

Here are some tips to help you be more successful with your New Year’s Resolutions:

1.Get rid of the words “always” and “never.” Don’t say that I am “always” going to go to the gym after work as there will be days that you simply can’t go every day at the same time. It is then too easy to say that “I blew it! I give up!” and just quit going to the gym altogether. Sometimes when people are going to lose weight they say “I am never going to eat chocolate again!” These statements are too rigid and absolute and don’t allow for the flexibility we all need in our lives.

2.Take your time. Lasting behavior change takes time to sink in and become routine. Additionally, our bodies need time to adjust to changes in physical activity, diet and quitting smoking, alcohol and caffeine.

3.Question why you are making a change. Are you quitting smoking because your spouse is nagging you incessantly? Are you trying to manage anxiety because your family said that you are driving them nuts? Successful life changes happen when we are able to identify what we personally plan to get out of that change. How will you FEEL if you quit smoking? Will you have more energy? Will you hopefully live longer to see your grandchildren grow up? How will your life be better if you finally get that claustrophobia under control? When we are able to connect with what WE will get out of making a change, we are far more likely to stick with it.

Best wishes for a happy, healthy New Year!

Dana Nolan, Mental Health Counselor


Tejal Parekh, RegisteredDietitian

Healthy Living Counseling, LLC

Some Thoughts on Holiday Stress and Anxiety

From the desk of Dana Nolan, Licensed Mental Health Counselor: It is that time of year again!  We will soon be seeing television commercials or images in magazines depicting families enjoying the holidays.  We see artfully decorated trees and beautifully set tables covered with perfectly cooked food.   Family members all appear to be getting along and are dressed in color-coordinated festive attire.

Do we ever see a frazzled mother frantically trying to get all the food on the table while it is still hot?   Where is that crazy relative who likes to tell jokes that not everyone thinks are funny?  We don’t see children running around the house excitedly fueled by too much candy or cookies.

Our lives usually feel stressful enough throughout the year. The holiday season can overwhelm us further if we feel compelled to live up to unrealistic expectations of what our holidays should be like.  Those “shoulds” can come from what we see in the movies or on TV.  They can come from childhood holiday memories.  The “shoulds” can be further fueled by pressure to keep up with the Jones’ down the road in terms how much money they spend on their children’s gifts or holiday decorations or similar stress and anxiety.

Take a moment and think about what is really important to you during the holiday season.  Think back on previous holidays and pick out your most enjoyable memories and do more of those things.   Stop for a moment when you think or feel a “should” about what you are doing this holiday season.   Where is that should coming from?   Is it a realistic and meaningful “should” that we have for our holidays?  If we can let go of unrealistic holiday expectations and focus on what is meaningful to us during the holidays, then we can get through this time of year more happily and healthfully!

Survivorship 101- “Getting Back to Normal After Cancer Treatment” Seminar in Winter Park Nov 16, 2013

Mental Health Counselor,  Dana Nolan will be the guest speaker for the Leukemia and Lymphoma Society on Saturday, November 16, 2013.  The “Survivorship 101 Getting Back to Normal After Cancer Treatment” seminar is being held at the Ruth’s Chris Steak House, 610 N. Orlando Ave., Winter Park, Florida.

This is part of an educational program series provided by the Leukemia and Lymphoma Society, that provides mutual support and education for family members.  If you or a loved one have a diagnosis of Leukemia, Hodgkins Lymphoma, Non-Hodgkins Lymphoma, Myeloma or Myelodysplastic Syndrome, this seminar will provide you with information about Survivorship and to help you learn strategies to cope with the common emotional, physical, and social challenges that cancer survivors face.  This is a great opportunity to discuss anxiety and concern with others who share the same experiences.

Dana Nolan is a Licensed Mental Health Counselor.  She is a member of Healthy Living Counseling which provides counseling services for cancer and other serious illnesses.

Pre-registration/RSVP by November 13, 2013 for this FREE Cancer Seminar provided by the Leukemia and Lymphoma Society is required.  Please refer to the flyer below for more information.




With an estimated 19 million Americans living with major depression, it is quite likely that you or someone you know is struggling with this very treatable condition. Some of the common symptoms of depression include: change in appetite; sleep problems; fatigue; feeling worthless, guilty or hopeless; lack of interest in things you used to enjoy; avoiding family and friends; poor concentration/memory; decreased motivation and suicidal thoughts.

As a therapist, I have found that the most challenging symptoms of depression are the ones that lead a person to believe that nothing will ever get better (hopelessness) and that no one cares about them or would miss them if they were gone (worthlessness.) It is these beliefs that keep a depressed person from reaching out for help.

A combination of anti-depressants and cognitive behavioral therapy is the BEST treatment available and improves symptoms of depression most of the time. If someone you care about appears depressed, tell them that you are concerned about them, offer to go the doctor with them and encourage them that things will get better if they reach out to professionals for help.

Dana Nolan
Mental Health Counselor
Healthy Living Counseling, LLC