Wow, thank you for writing this. I felt like someone was hugging me and saying - everything you are feeling is valid and real, here are the facts behind it. Thank you so much for the call out as well, grateful for this community of people who can support each other in the awfulness that is cancer. xx
Thank you Dr Malarkey for this. My nervous system is on high alert still and it’s been 2.5 months since the radiation. Add to this 6 years of long COVID and no wonder I have trouble sleeping!
This is an outstanding, compassionate piece, and it captures a clinical truth survivors often feel ashamed to say out loud: the scan can be “clear” and the body can still be in threat mode.
A few things I especially appreciated as a physician-scientist:
1. The framing is correct and relieving: this isn’t a “gratitude failure,” it’s neuroendocrine + immune physiology. Prolonged treatment is a prolonged alarm state; the autonomic system and HPA axis don’t instantly stand down just because the calendar says “done.” 2. Your cortisol discussion is grounded and practical, flattening/inversion of diurnal patterns mapping onto insomnia, fatigue, and anxiety is exactly the kind of “invisible” dysregulation patients experience. 
3. I also love that you treat sleep as a core repair pathway, not a lifestyle footnote, and that you differentiate etiologies (cortisol rhythm, hypervigilance/trauma, pain, chemo-induced menopause) rather than pushing one generic fix. 
4. The gut section is quietly one of the most important: mucosal injury, antibiotics/PPIs, microbiome depletion → whole-body effects (immune tone, mood, estrogen metabolism) is a reality many oncology pathways still under-address. 
If I had one “yes, and” to add: what you’re describing is also a transition-of-care gap. We discharge people from intensive monitoring without giving them a structured “recalibration protocol” (nervous system + sleep + circadian anchors + graded activity + psychosocial support). Your “first 90 days” roadmap is exactly the kind of survivorship container that should be standard.
Thank you for writing this with both scientific clarity and emotional precision! It will help people stop interpreting a normal physiologic aftermath as personal weakness.
Dear Rita, thank you for sharing this. The grief of who we were before treatment is so real, and it sounds like you're carrying an enormous physical burden on top of that. I don't have answers about letting go, but I do know that mourning what was lost is part of the work, not something to rush through. You're not alone in this. The fact that you're still here, still seeking, still trying to figure it out—that matters : ) And while it's not quick, some of that emotional and physical weight can lighten with the right, individualized support over time. It is possible. Sending you gentleness as you navigate this.
Wow, thank you for writing this. I felt like someone was hugging me and saying - everything you are feeling is valid and real, here are the facts behind it. Thank you so much for the call out as well, grateful for this community of people who can support each other in the awfulness that is cancer. xx
thank YOU for creating a space for connection inspire of awfulness of cancer. Big, BIG hug 🤗
I wish I could ban all use of “back to normal” with cancer patients.
I agree
Thank you SO much for the mention, especially in such esteemed company!
Thankyou so much for this
As a stage 3 prostate cancer guy following radiotherapy I am nearly 9 months after stopping Hormone Therapy. ( 3 years 9 months)
People that surround me think that it is like a switch back to some sort of normality
Testosterone return seems slow so slow.
But it seems fatigue, return of hot flushes continues. Most of all it is an explosion of emotional turbulence seemingly out of my control
It is like my emotions are on a childs bouncy castle. like a gymnast on a trampoline, sky diving without a parachute.
Some regaining of control means I have reins on my emotional kite.
It is comforting to know that just perhaps it is not my failure but post treatment ( if that is truly so, of course)
side effects that the body in seeking previous balance albeit slowly
I certainly take on board the importance of sleep for energy and yes REM
As an Old codger PC guy all too often disturbed of course
C'est la vie
But thankyou again for your insights.
Thank you for sharing you story and for those image!. A bouncy castle, a kite with reins. You’ve said it better than any clinical description could.
Nearly 9 months post-ADT after almost four years is still very early. You’re not imagining it. And you’re not alone in it.
Totally agree with this. Healing needs the same level of care and planning as treatment did.
Thank you.
Thank you for sharing this, it was very intriguing.
Thank you Dr Malarkey for this. My nervous system is on high alert still and it’s been 2.5 months since the radiation. Add to this 6 years of long COVID and no wonder I have trouble sleeping!
This is an outstanding, compassionate piece, and it captures a clinical truth survivors often feel ashamed to say out loud: the scan can be “clear” and the body can still be in threat mode.
A few things I especially appreciated as a physician-scientist:
1. The framing is correct and relieving: this isn’t a “gratitude failure,” it’s neuroendocrine + immune physiology. Prolonged treatment is a prolonged alarm state; the autonomic system and HPA axis don’t instantly stand down just because the calendar says “done.” 2. Your cortisol discussion is grounded and practical, flattening/inversion of diurnal patterns mapping onto insomnia, fatigue, and anxiety is exactly the kind of “invisible” dysregulation patients experience. 
3. I also love that you treat sleep as a core repair pathway, not a lifestyle footnote, and that you differentiate etiologies (cortisol rhythm, hypervigilance/trauma, pain, chemo-induced menopause) rather than pushing one generic fix. 
4. The gut section is quietly one of the most important: mucosal injury, antibiotics/PPIs, microbiome depletion → whole-body effects (immune tone, mood, estrogen metabolism) is a reality many oncology pathways still under-address. 
If I had one “yes, and” to add: what you’re describing is also a transition-of-care gap. We discharge people from intensive monitoring without giving them a structured “recalibration protocol” (nervous system + sleep + circadian anchors + graded activity + psychosocial support). Your “first 90 days” roadmap is exactly the kind of survivorship container that should be standard.
Thank you for writing this with both scientific clarity and emotional precision! It will help people stop interpreting a normal physiologic aftermath as personal weakness.
Dear Rita, thank you for sharing this. The grief of who we were before treatment is so real, and it sounds like you're carrying an enormous physical burden on top of that. I don't have answers about letting go, but I do know that mourning what was lost is part of the work, not something to rush through. You're not alone in this. The fact that you're still here, still seeking, still trying to figure it out—that matters : ) And while it's not quick, some of that emotional and physical weight can lighten with the right, individualized support over time. It is possible. Sending you gentleness as you navigate this.