Managing Unintentional Weight Loss During Mesothelioma Treatment

Mesothelioma cancer and its treatment may cause a variety of side effects.

These symptoms can diminish a patient’s ability to eat well and lead to unintentional weight loss — a person losing weight without trying.

Some patients put a positive spin on cancer-associated weight loss.

Unfortunately, losing weight unintentionally during treatment can make your treatment harder and less effective.

If your weight is decreasing and you’re not on a diet, it’s a red flag.

Harms of Unintentional Weight Loss

Under normal circumstances, weight loss can benefit your health if you carry excess fat.

However, cancer treatment is far from a normal situation.

With cancer, the body often cannot respond to weight loss in a healthy way. This is particularly true if the weight loss is unintentional.

The stress and inflammation on the body during cancer care can prevent the use of fat for fuel. This is true even in people who carry excess body fat or have been told they are overweight or obese.

Instead, patients end up losing lean tissue. Lean tissue is made up of muscle, organs, red blood cells, platelets and immune cells. This is why losing weight unintentionally during cancer treatment is so harmful.

Not only do you feel weak and fatigued from losing muscle mass, but the very cells and tissues needed to keep your immunity and your body strong through treatment are depleted.

This can lead to more severe treatment side effects, treatment dose reductions and breaks in scheduled therapy. These things hinder recovery and make it harder to reach your treatment goals.

Who Loses Weight During Cancer Treatment?

Anyone with cancer can lose weight during treatment. However, certain cancers significantly raise the risk of unintentional weight loss.

People with malignant mesothelioma, myeloma or cancers of the lung, head and neck, kidney, esophagus, pancreas, stomach or intestinal tract often experience unintentional weight loss during treatment.

Cancer patients can require more protein and calories than usual to meet basic nutrition needs, withstand cancer therapy and recover.

An April 2018 study published in the British Journal of General Practice found many cancer patients lose weight without trying before treatment even begins.

Some treatments cause pain when eating and an inability to properly digest food and absorb fats, carbohydrates, vitamins and minerals. Although it sounds scary, a feeding tube and special nutritional formulas can be lifesavers.

All of these things highlight the importance of consulting with a registered dietitian who can develop a tailored plan to meet each patient’s individual nutrition needs.

Mesothelioma Nutrition Guide

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Eating right and balancing your diet while undergoing mesothelioma treatment can help ease your symptoms.

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Make Good Nutrition a Priority

The most common nutritional problems for mesothelioma patients include consuming too little protein and too few calories.

Try the following tips to help yourself meet protein and calorie needs:

  • Eat Often: Enjoy multiple small meals throughout the day instead of three large ones.
  • Snack Frequently: Snack whenever you are hungry. Enjoy what you like without guilt about healthy or unhealthy foods.
  • Make Liquids Count: Focus on high-calorie liquids. Try smoothies with protein powder, bananas and peanut butter.
  • Skip Empty Calories: Avoid large amounts of tea, coffee or diet drinks and foods.
  • Sip Sparingly: Have most liquids after meals. Liquid can fill you up before you have a chance to consume the nutrient-dense foods on your plate.
  • Focus on Protein: Include poultry, fish, eggs, beans, nuts or peanut butter at each meal or snack.
  • Juice It: Juice fresh fruits and vegetables to obtain nutrients without filling up. If you don’t own a juicer, blend fruit or vegetables with water, then strain with a cheesecloth. Cheesecloth is inexpensive and available at most grocery stores.
  • Have Breakfast for Dinner: Consume your favorite foods any time of day. If you love breakfast foods, have them for lunch or dinner.

Mesothelioma treatment can take a toll on your ability to eat well. Ask your doctor or nurse for a referral to a registered dietitian who is a cancer nutrition specialist.

Swimming Can Help Mesothelioma Patients Stay Active

As I approached my 39th birthday last year, I decided I should take better care of myself.

I didn’t really diet, I just started being more active. I started swimming, walking and working out occasionally.

One year and 65 pounds later, I feel better. I also have more energy than I did before. I am beginning to think all the exercise gurus might be on to something.

Mesothelioma patients can also tap into the benefits of exercise and a healthier lifestyle.

The trouble with benefitting from fitness training is that some cancer patients may not feel up to a strenuous workout.

If that’s the case, there are many different types of physical activities that might be a better fit than the more traditional gym workouts.

Some of the Many Benefits of Being Active

Back when I was comfortable with my sedentary lifestyle, I felt tired all of the time.

I couldn’t visualize myself willingly adding to my long, daily to-do list. My workday, managing my home and parenting my kids was all I thought I could handle.

Ironically, overcoming fatigue is one of the many health benefits of being more active.

Mesothelioma patients often experience fatigue, especially during chemotherapy and radiation treatments. However, incorporating just a little physical activity into a daily routine has many benefits and can increase a cancer patient’s quality of life.

Exercising can improve the mental and physical health of people living with mesothelioma.

A few of the many health benefits of exercise include:

  • Feeling less fatigued
  • Boosting muscle mass
  • Increasing physical strength

Patients and caregivers should consult their oncology team when designing an exercise plan.

Doctors and their patients can explore many low-impact, strength-training programs to find the right fit.

Breast Cancer Patients Benefit from Swimming

When considering various physical activities, people may overlook exercise programs that aren’t always found in the gym such as yoga, walking and even swimming.

Just because it doesn’t involve free weights or a fitness trainer, doesn’t mean it isn’t beneficial.

An article published in Strength and Conditioning Journal illustrates the many health benefits patients with breast cancer experience through swimming.

According to the article, many oncology professionals are moving away from the outdated “chemotherapy and bed rest” approach to cancer treatment.

Some of the many benefits breast cancer patients experience from regular exercises, such as swimming, include:

  • Increase in red blood cell count and blood volume
  • Increased delivery of oxygen to vital organs
  • Boost in physical energy and cardiovascular function

Mesothelioma Patients May Benefit from Swimming

My father purchased his dream home in 1989. His criteria was a fireplace and a swimming pool.

Dad always enjoyed swimming, and after doctors diagnosed him with stage IV mesothelioma, that didn’t change much.

Our oncologist told us that swimming could help increase Dad’s stamina and range of motion. Just like breast cancer patients, my father’s health improved with swimming.

Dad loved having friends and family over to swim. He hosted pool parties throughout the summer of 1993.

Swimming provided a way for him to maintain his physical health and his mental well-being.

Dad lounged by the pool, socializing with friends and family part of the time. And when he felt up to it, he’d swim a few laps. My father felt better when he was able to be more physically active.

When we discussed pool parties with Dad’s oncology team, doctors touted the physical benefits of swimming, but also shared a few words of caution with my family regarding their concerns about Dad’s immune system.

Dad was careful to follow the doctors’ swimming guidelines.

Cancer Treatment and Exposure to Germs and Irritants

Most cancer patients and their families understand the impact of cancer treatments on the human body.

Chemotherapy and radiation treatments pack a punch for treating cancer, but also have numerous side effects.

Among the side effects of treatment are fatigue, hair loss, skin irritations and a weakened immune system.

Sometimes, treatment side effects can interfere with patients’ swimming safety.

  • Skin Irritation: Some cancer patients experience skin irritations or have especially sensitive skin following treatment. Swimming in chlorinated pools or excessive sun exposure can make already irritated skin even worse. Be sure to check with the oncologist about potential skin problems before entering the water.
  • Immune Deficiency: Cancer treatments can weaken patients’ immune systems by lowering blood counts. Swimming in a crowded public pool can increase exposure to germs. Similarly, swimming in lakes, ponds, creeks or the ocean increases one’s risk of germ exposure. It is essential to check with the oncology team to know what swimming environment is safest for you.

Cancer patients undergoing treatment may not feel as though an exercise plan is realistic for them.

It might be difficult to envision a physical fitness regimen when feeling fatigued from chemotherapy treatments.

Oncologists, caregivers and patients can work together to design a realistic plan that is beneficial and approachable.

Swimming provides a fun and social way to incorporate physical fitness into cancer care.

Water reduces the impact of exercise on stiff joints and sore muscles while providing enough resistance to build muscle strength.

Maintaining range of motion, muscle tone, flexibility and stamina are vital aspects of physical health that are essential in preserving cancer patients’ quality of life.

Easing Cancer Worries at the Ballpark

I distinctly remember the crackling sound of the radio as my father listened to baseball games on many Saturday afternoons.

Dad was a lifelong, die-hard Cincinnati Reds fan.

In all his 45 years, I can count on one hand the times he missed a Reds game. Win or lose, my father would always cheer them on.

We ventured down to Riverfront Stadium at least once each summer to watch a game.

Usually, we got cheap seats in the nosebleed section, but it never mattered to me. I just enjoyed seeing all the people, the smell of stadium hotdogs and singing “Take Me Out to the Ballgame.”

The summer of 1993 was no different for my father.

Despite his mesothelioma diagnosis, Dad didn’t miss seeing the Reds play that year.

It was a bit different for us, but he was still there, cheering for his favorite team. Dad needed a break from cancer treatments, medications, doctors and hospitals.

All of it was just too much. He just wanted to be a regular baseball fan.

Somehow, that game rejuvenated his soul.

Reclaiming Joy Despite a Cancer Diagnosis

Dealing with cancer can be overwhelming at times. Cancer patients and their caregivers may feel bombarded by the diagnosis, treatment options and changes in their daily lives.

It is easy to get caught up in the demands and challenges of treatment. People dealing with cancer may forget the little things in life that give them joy.

Sometimes it is helpful to reclaim the happiness found in life’s little gifts.

It could be a piping hot cup of coffee first thing in the morning, the sun rising over the horizon, or the perfect cheap seat in a baseball stadium.

Cancer patients and their caregivers must maintain their physical health as well as their mental well-being.

My father found his joy in the crack of a bat and the roar of the crowd. Baseball helped Dad feel better, despite dealing with mesothelioma.

Is Attending a Major League Baseball Game Out of Reach?

Attending a sporting event at a stadium may seem out of reach for certain cancer patients and caregivers.

For some advanced-cancer patients, the walking, outdoor weather and sheer crowd size may feel overwhelming.

If physical limitations or medical restrictions interfere with your ability to attend a game, it might help to explore other options.

  • Attend a Local Event: If watching a game in a crowded stadium is overwhelming, it might help to scale it down a bit. Local high school and Little League games might be a better fit. Smaller fields have all the nostalgia of America’s favorite pastime, but on a more approachable level.
  • Host a Baseball Party: Some patients undergoing cancer treatment may not feel up to leaving home to attend a ballgame. Throwing some burgers or hotdogs on the grill, roasting some peanuts, and gathering around the living room to cheer on your favorite team may lift everyone’s spirit.
  • Listen to a Game the Old-School Way: For those not feeling up to having company, or getting out and about, listening to their favorite team on the radio can bring back fond childhood memories. Hearing the excitement in the announcer’s voice and the stadium ambiance can positively impact a person’s mood.

When nothing else but an in-person baseball experience will do, there are ways to avoid all of the hassles of attending a game by taking advantage of ballpark accommodations.

Take Advantage of Special Accommodations

For some baseball fans facing cancer, nothing but a view from the stands will be enough.

In such cases, a little planning can make the trip much easier. Most stadiums and event facilities have special accommodations to meet the needs of all their patrons.

Many event coordinators go above and beyond the average wheelchair ramp and automatic door.

Great American Ball Park — home of the Reds — is not alone in their accommodations.

  • Accessible Parking: Most stadiums offer accessible parking spaces for visitors with mobility issues or other medical needs. These parking areas are located closer to entrances, making it much easier for patrons to access the facility.
  • Drop-Off and Pickup Zones: Many large venues have designated areas near the entrances as drop-off and pickup zones. Drivers can drop off their family members at the entrance and then go park their vehicle. For cancer patients, this accommodation eliminates excess walking through parking areas to get to the stadium.
  • High-Tech Assistance: Some facilities offer mobile assistance to patrons. By simply texting a specific number on a mobile device, baseball enthusiasts can reach security professionals, access park information and even order concessions.
  • Mobility Assistance: Many ballparks offer free mobility assistance for patrons with physical limitations. Park employees can assist patrons to their seat using a wheelchair, and then help them get back to their vehicle after the game.

Baseball fans who happen to live with cancer don’t have to give up rooting for their favorite team.

Whether watching television, listening to the radio or attending a live event, fans can reclaim their joy in America’s favorite pastime.

With a little planning, the seemingly impossible can be within reach. When planning to attend a major sporting event, it is also important for cancer patients and caregivers to check with their oncology team.

Doctors can help plan for cancer-related needs people might otherwise overlook such as sun exposure, oxygen use and treatment planning.

Pros and Cons for Mesothelioma

In June 2017, a fundraiser launched to help a mesothelioma patient take part in a clinical trial. Thanks to the support of hundreds of donors, the campaign surpassed its $40,000 goal.

They raised more than $53,000 in a matter of months.

In contrast, another mesothelioma patient’s September 2016 fundraiser fell far short of its $12,500 goal, raising less than $4,000 from a few dozen donors.

These two examples share a very rare diagnosis and an increasingly common way of trying to pay for health care.

Both campaigns used It is one of the many crowdfunding websites available to help people raise money for anything — especially cancer treatment.

In March 2017, an article on celebrated crowdfunding as a “virtual safety net” for cancer patients and caregivers.

But in January 2018, a writer for the Financial Times criticized crowdfunding as a “Band-Aid solution” for America’s health care problems. He ended his analysis of crowdfunding by calling it a “sad, painful, essential form of salvation.”

This controversy stems from the fact that websites like were not originally intended to cover gaps in health insurance coverage.

Crowdfunding websites offer an efficient way to benefit from the generosity of strangers all over the world. Successful crowdfunding is not easy, though, and it comes at the cost of privacy.

How Does Crowdfunding Work?

On a crowdfunding website, you describe your financial need through text, images or a video. Anyone who decides it is a worthy cause can then contribute in any amount through an online credit card transaction.

Crowdfunding started out as a way for artists and designers to raise startup money directly from people interested in their projects. Over time, the method caught on as a convenient way for people to raise funds from friends and family for weddings and other personal events.

It was only a matter of time before cancer patients and caregivers became a primary market for these websites. Health care in the U.S. becomes less affordable every year.

The crowdfunding industry has embraced this shift. devotes a special section of its website to cancer patients. It markets itself as “the world’s #1 site for cancer fundraising & crowdfunding.”

Other crowdfunding sites such as specifically serve humanitarian causes and individuals in dire need.

These websites have fewer administrative costs than traditional brick-and-mortar charity organizations. In many cases, they only charge users a processing fee to cover the cost of each credit card transaction.

Advantages of Crowdfunding for Mesothelioma

It’s a familiar story in all areas of medicine: As treatment improves, it also becomes more expensive.

Treatment for mesothelioma is no exception.

Even with health insurance, mesothelioma patients may have to pay tens of thousands of dollars in deductibles, copays and coinsurance. Added to this are the indirect costs of traveling for specialized treatment and losing income when patients or caregivers cannot work.

Without enough financial resources, a patient’s health may suffer because of financial toxicity.

Turning to others for help is one solution. A crowdfunding website can streamline this effort and make fundraising more effective.

  • Reaches More People: An online crowdfunding campaign can circulate through social media channels such as Facebook. The patient’s story can rapidly go beyond their immediate circle of family and friends.
  • Makes Asking and Giving Less Awkward: Discussing an illness and financial stress in person can be difficult. Writing and reading about it is more comfortable for many people.
  • Provides Emotional Support: Along with the financial contributions, many donors comment on crowdfunding pages with words of comfort and encouragement.

Downsides and Risks of Cancer Crowdfunding

Another familiar story is that nothing on the internet is as simple as it seems.

Crowdfunding has been a blessing to many of its users — but not all of them. No crowdfunding campaign guarantees success. Even successful ones can be mixed blessings.

Many critics describe the crowdfunding model as a “popularity contest.” In this perspective, these websites turn cancer patients’ tragic stories into products that have to compete for attention in a crowded marketplace.

Before someone commits to a crowdfunding campaign, they should consider the negatives involved.

  • Depends on Marketing Skills: Launching and maintaining an effective crowdfunding campaign takes a lot of work.’s article includes a detailed discussion of “strategies for fundraising success.”
  • Sacrifices Privacy: Crowdfunding cancer treatment means putting the patient’s health status and financial situation into the public eye.
  • Attracts Con Artists: If someone else sets up a crowdfunding campaign on behalf of a cancer patient, that person may take the money and run.

Crowdfunding holds great potential, but it is only one of many types of resources cancer patients can turn to.

Mesothelioma patients should explore every type of financial assistance available.

5 Places You Wouldn’t Expect to Find Asbestos

This week marks the 14th annual Global Asbestos Awareness Week.

This year, the campaign focuses on banning asbestos, preventing exposure, enforcing regulations and strengthening international partnerships.

It’s easy to assume that asbestos exposure is a risk of the past.

Most Americans think asbestos was banned long ago.

It wasn’t.

The U.S. Environmental Protection Agency (EPA) tried to enact a ban in 1989, but the Fifth Circuit Court of Appeals overturned it.

Asbestos use is regulated in the U.S., but not banned. Only a handful of products, such as flooring felt, spray-on insulation and commercial paper, cannot contain asbestos. Many products are legally allowed to contain asbestos, and most of them are construction materials.

Because asbestos is so widely used in construction, places we regularly associate with safety are a source of asbestos exposure.

Churches, schools, public buildings, hospitals and your own home are among places that may contain asbestos.

Make sure your family and loved ones know the places where asbestos may be lurking. The only way to prevent mesothelioma and asbestosis is to avoid asbestos exposure.


Churches primarily used asbestos materials for soundproofing and fire prevention.

People don’t often associate asbestos with soundproofing, but asbestos was added to acoustical panels to make them stronger. Acoustical panels were used on walls and ceilings to soften the echo and reverb of music played inside churches.

Asbestos was also used to insulate church organ blowers and bellows. Another form of asbestos insulation found in churches includes wrap insulation around boilers and steam pipes.

The following churches have dealt with asbestos abatement issues in recent years:

  • Rose of Sharon Primitive Baptist Church in North Nashville, Tennessee
  • Barrington Congregational Church in Barrington, Rhode Island
  • Our Lady of Lourdes Church in Seaford, Delaware

Maintenance workers are the most at risk of asbestos exposure in churches. But anyone who works at a church, especially older churches, may encounter asbestos products.


Asbestos is so prevalent in schools that the U.S. government created a separate set of regulations in 1986 to protect children and school employees.

The Asbestos Hazard Emergency Response Act (AHERA) requires schools to inspect buildings for asbestos-containing materials, make asbestos management plans and take action to prevent and reduce asbestos exposure risks.

Although AHERA was enacted in the late 1980s, asbestos remains a problem in schools. In 2017, the EPA awarded $631,000 to five New England state agencies to fund asbestos abatement projects and asbestos management plans.

Where you may find asbestos in schools:

  • Insulation around pipes
  • Insulation around boilers
  • Vinyl flooring
  • HVAC ductwork
  • Ceiling tiles

Public Buildings

Any public building built before the 1980s is likely to contain asbestos-containing construction materials. Even new buildings are built with asbestos in roofing materials, vinyl tiles and cement piping.

Examples of public buildings include government buildings, police stations, movie theaters, restaurants, barbershops and hair salons, grocery stores, shopping malls and airports.

When asbestos is discovered in these buildings, federal regulations require building owners to safely abate and properly dispose of asbestos materials. Those who fail to follow regulations are fined. Some people have even served time in jail for violating asbestos laws.

In 2014, asbestos was found in a Connecticut police station’s plaster ceiling. The Occupational Safety and Health Administration fined the Stamford Police Department $2,720 and issued five violations for improperly handling asbestos materials.

You may encounter the following asbestos products in public buildings:

  • Curtains in movie theaters
  • Hair dryers in barber shops and salons
  • Talcum powder products in barber shops
  • Construction materials in government buildings
  • Asbestos insulation around pipes and boilers


Hospitals used asbestos products to prevent fires and keep medical equipment from overheating.

Anyone who works in a hospital may come in contact with these products, but maintenance workers are most at risk of exposure.

Demolition and construction workers who work on hospitals are also at risk.

In 2011, the discovery of asbestos-contaminated flooring delayed plans to demolish Ivinson Hospital at the University of Wyoming.

Asbestos in hospitals is also an international concern. The toxic mineral was widely used in Australian hospitals.

Where you may find asbestos in hospitals:

  • Insulation around piping
  • Insulation around boilers
  • Cooling towers
  • Electrical wiring insulation
  • HVAC ductwork
  • Floor tiles

Your Own Home

There’s a good chance your home contains asbestos, even if it is a new home. People associate asbestos with older homes, but many new homes are constructed with asbestos materials.

The most common asbestos construction materials used today include cement shingles, sheets and pipes, roofing and flooring materials, pipeline wrap and millboard.

Hundreds of old construction materials were made with asbestos. The most commonly encountered asbestos materials in older homes include:

  • Attic insulation
  • Popcorn ceilings
  • Plumbing fixtures
  • Electrical panels
  • Vinyl floor tiles
  • Drywall and cement sheets
  • Plaster, putties and caulking materials
  • Boiler and fireplace insulation

Homeowners are advised against performing their own do-it-yourself asbestos removal projects.

It is important to hire a reputable asbestos abatement company to safely remove asbestos from your home. Abatement professionals know how to protect you and your family from unnecessary asbestos exposure.

Lifting Your Self-Esteem Despite a Mesothelioma Diagnosis

In my 20 years of providing counseling to cancer patients and families and facilitating cancer support groups, I have found that there are many common emotional and psychological effects that accompany any cancer diagnosis, including mesothelioma.

Anxiety, depression and sleep problems are prevalent effects of cancer, and cancer patients can expect them. But low self-esteem, which is also common, can be unexpected and underreported by people diagnosed with cancer.

I have had many cancer patients admit in counseling sessions that they don’t feel as good about themselves since their cancer diagnosis. They report feeling “less than” the person they were before they were diagnosed.

Many cancer patients don’t tell their loved ones about their diminished self-esteem because they may feel pressured to be strong or invincible as they battle their disease.

Because of the types of treatments and side effects, some mesothelioma patients believe they look sick, unattractive and feel useless. Scarring from surgery, weight loss and shortness of breath are mesothelioma symptoms or treatment effects that can affect how we view ourselves and our self-worth.

What Is Self-Esteem?

It is a common misconception that self-esteem is the same as self-confidence or body image.

Our self-esteem does include how we perceive our looks (self-image) or self-confidence in our ability to do something. But self-esteem is actually the “value” that we have in ourselves and our perception of the value that we add to the world around us and to those in our lives. Our self-esteem affects our moods, behaviors and relationships.

People with healthy self-esteem recognize their worth as a human being and typically feel confident and strong. They also have faith in their ability to solve problems and overcome adversity, and they have a realistic sense of optimism. When a person’s self-esteem is waning, they typically feel unworthy and may be less likely to take care of themselves — emotionally or physically.

Why would they feel this way? Because they don’t feel they are worth taking care of. Poor self-esteem can lead to pessimism, fear and hopelessness.

How Can Mesothelioma Affect Our Self-Esteem?

Being diagnosed with mesothelioma or any serious, chronic illness may lead to a decrease in self-esteem for many reasons such as:

  • Not feeling well and not participating in social or physical activities like before
  • Feeling we are a burden to those we love because we require help or assistance
  • Being ashamed of our appearance because our looks may have changed and people may treat us differently

Many people define their worth or value by what they are able to do, their ability to work and their independence.

Mesothelioma treatment can temporarily affect looks and abilities, and one’s thoughts can become negative with inner conversations such as “I am useless because I can’t drive right now,” or “My wife will leave me because I am sick and can’t work.”

People with low self-esteem tend to notice what is wrong with them, instead of what is right with them.

Maintaining a Healthy Self-Esteem

If you notice that your self-esteem is slipping while you are battling mesothelioma, there are a few things you can do to feel better about yourself.

The first step is to begin to notice your self-talk (what you are saying to yourself about your worth and value to others) and whether you are focusing on your faults or feeling useless, ugly or a burden to others.

To work on raising your self-esteem, you have to focusing on truthful positive statements about yourself and challenge your negative self-talk.

Here are some other tips:

  • Make a list of your good qualities and what others have said they love about you such as your sense of humor, determination, honesty, kindness, courage, etc.
  • Recount your accomplishments

You can also develop some positive affirmations, or statements that you would like to believe, such as “Even though I have cancer, I am still a good partner (parent, friend, etc.),” “I am lovable despite looking sicker than I used to” and “I am strong and courageous and I will get through this.”

It may be necessary to re-evaluate how you determine your value and self-worth.

Some people believe their value is directly related to how much money they make or their productivity. A cancer diagnosis can lead to a healthy re-evaluation of this belief.

Those who love us do not feel that way because of how hard we work or how clean our house is. Our value to others is often linked to how we love them and show that love.

With some self-awareness and a little effort in refocusing our self-talk, it is possible to maintain a healthy self-esteem during mesothelioma treatment.