When a Loved One has Thoracic Outlet Syndrome (TOS)
From the moment your loved one was diagnosed with TOS, you’ve probably gone through an entire range of emotions. Family members and friends of women with TOS have said that they feel angry, sad, anxious, scared, and lonely. One or more of these feelings may come and go, or you may have all of them at once, and they may continue as your loved one goes through treatment and even after treatment has ended. Family members have also said that they want and need to do something to help, but that they don’t always know what to do or how to do it.

"But you don't look sick..."

Helping Your Loved One
Often family members and friends don’t know where to begin to help their loved one. There are some tips that others in your situation have found helpful:
• Spend time and talk with them. Let them take the lead. If they want to talk, be a good listener.
• All it takes sometimes is a touch or a hug to let someone know you care. It doesn’t have to be a long conversation. Just being there is important.
• Try to feel comfortable when there is a lull in the conversation. Silence can often be comforting.
• Remember that they may not always want to talk or think about TOS.
• Help put TOS in perspective by obtaining accurate, factual, and honest information.
• Be an educated family member or friend. Know what resources are available. Seek out new, reliable information from your healthcare provider, from the TOS web sites, your local library, and local support groups.
• Help them find a healthcare provider who understands them and meets their needs.
• Try to involve them in as many shared activities as they would like. Play cards, watch movies, go out to dinner, or go shopping.
• If you don’t live with them, continue to visit, call, e-mail, or write.
• Keep your promises. If you say you are going to stop by, follow through. Understand if they tire quickly and you can’t stay as long as you expected. Learn to read signs that they need rest or time alone.
• Encourage them to do things with others.
• Run simple errands. Often these small tasks seem insignificant but can provide great relief to them and their family.
• Write a little note letting them know you are thinking about them or make a quick phone call.
• Allow them privacy.
• Discuss needed changes in family roles and activities. Decide what is important, what needs to be done, what can be delegated, and what can wait.
• Don’t minimize the effect of TOS but don’t be overprotective.
• Most importantly, be yourself!

Communicating with Your Loved One about TOS

Why is it hard to talk about TOS?
Many people feel that it’s very hard to talk honestly with their loved ones about TOS. You may feel like you have to protect them. Or you may feel like they have enough to worry about without worrying about your stress, or your problems, or your emotions. You may worry that if you talk about your fear or anxiety, you may make them scared, or anxious, or you may make them lose hope.

Communicating more effectively with your loved one:
These are some tips others have found helpful when trying to communicate with their loved ones with TOS:
• Express your feelings and try to communicate openly. This is crucial to creating a healing environment and for helping one another gain the strength necessary to deal with TOS.
• Give your loved ones permission to openly express their feelings. Some patients may keep feelings bottled up for fear of worrying or scaring their family and friends.
• Let your loved one know that it is OK to cry in front of you and that it is not a sign of weakness to express emotion.
• Try to set aside time every day to talk to each other without interruptions. Turn off the ringer on your phone, turn off the television, don’t answer your doorbell, etc.
• Use "I" statements, such as "I feel angry when . . ." or "I feel frustrated because . . ." or "I feel sad because . . ."
• Clarify statements with each other: "I heard you say . . . is that right?" If you think your loved one misunderstood something you said, try saying it a different way.
• Try to avoid serious discussions when you are tired or angry. Messages are more likely to be poorly communicated.
• Don’t stop making plans for the future. Discuss life goals and plans for when recovery goes well but also if the condition exists as a chronic condition. Talking about this can help both of you be ready for what the future brings.

Communicating with Others about Your Experience

Why is it important to communicate with others about what you’re going through?
The experience of TOS affects the entire family, as well as friends and co-workers. As a family member or friend of a person with TOS, you are not alone. Just as you are working to cope with the TOS of your loved one, friends, co-workers, and other family members are affected too. Children and parents face uncertainty and misunderstanding. Co-workers worry and may also have to deal with crises and interrupted schedules. Everyone needs support—learn to ask for help and encourage others to do the same.

With permission from your loved one, explain to friends and co-workers what is going on, so they can understand if you have to change your plans.

There are no disadvantages to having support in place, in case you need it. Keep in touch with your friends, family, and anyone else who supports you.

Most importantly, in your role as a support person for loved ones who have TOS, you may find that you need help in helping them. Asking for help is a sign of strength and taking control.

Knowing how and when you should ask for help from others:
It’s never too early to ask for help from a variety of sources. Ask in advance of needing the help, if you can. This gives them time to plan too. Have friends and family assist you with . . .
• Accompanying your loved one to doctor and treatment appointments.
• Babysitting, or taking kids to activities.
• Creating a list of "how family and friends can help" and see if they can come up with their own ideas.
• Spiritual help—prayers, meditation, rituals, scripture reading, getting to church or communion, etc.
• Emotional help—sharing, crying, laughing, etc.
• Practical help—chores, housework, laundry, transportation, getting information, etc..
• Appoint one of your friends or family to organize everyone else. You may not have to identify needs—they may do it for you.
• Have one friend or family member be the contact person for information and news. Then he/she can pass on information to the rest of your support network.
• If communication is difficult, seek the assistance of a licensed counselor, therapist, or clergy member.

Here are some suggestions on what you could ask for.
• "Please help us with our shopping."
• "We need a hug."
• "I would like you to help by inviting my loved one out and taking her places."
• "We would love it if you’d water our flowers!"
• "Please pray for us and share your faith with us."
• "Talk to us about the future; hope is important to us."
• "I/she would love a call when you have a minute to just talk."
• "We enjoy getting mail or e-mail.
• "Could you help me (or my loved one) with chores? We still have dirty dishes, clothes, and a house that need cleaning."
• "Bring a positive attitude; it’s catching."
• "Please help me/her feel good about myself/herself."
• "Can you take our children or us somewhere?" Be specific.
• "We might need transportation to her treatment, to her doctor’s office, or the store."
• "Could you walk or feed our pet?"
• "I’d like you to just listen to me/her."
• "Make us laugh, tell us jokes and funny stories. TOS has not taken away our sense of humor."
• "Talk to me about my concerns about them having TOS and how that has changed me, without thinking I have a negative attitude."

Lotsa Helping Hands is an organization that provides an on-line tool to assist in organizing support. This free web-based service helps manage and simplify everyday tasks of family, friends, colleagues, and neighbors wishing to help loved ones in need. For more information go

Communicating with Children about TOS:
Why is it important to tell children about a loved one’s TOS?

TOS is a difficult secret to keep from children. Often children will know something is wrong. They may sense your worry, or overhear your conversations, or unknowingly, friends may talk to them about it before you do. Without appropriate, accurate information, children may imagine the worst. In addition, if you keep information from them at first, they may not trust that you are telling them the truth later on.

What should children be told about TOS?
What and how you tell children about TOS depends on their age. The goal should be to talk to them at a level they can understand and in a way that they can be prepared for the ways they may be affected. According to the American Cancer Society (ACS), all children need to know . . .
• The name TOS including the part of the body that is affected—"TOS."
• How it will be treated.
• How their own lives will be affected.

It is also important to talk with them and reassure them about other worries they might have.

Some common concerns that children have voiced include:
• Concern that something they did or said may have caused their loved one’s illness. Most children blame themselves at some point in their loved one’s illness. Unfortunately, most children will not bring this up on their own, so it’s important to reassure kids about this rather than waiting for them to share their worry.

Communicating with Healthcare Providers
Note: In order to maintain your loved one’s privacy, healthcare providers are required to ask permission from your loved one before sharing any of them healthcare information with you.

Why is it important to communicate with healthcare professionals?
Almost everyone feels better and more in control when they understand an illness, how and why it is being treated, and what kinds of side effects may occur. However, many people have a difficult time talking with doctors or nurses. Some feel uncomfortable asking questions or talking about their loved one’s cancer and treatment because they’re afraid they might look foolish or ask a silly question. Some are afraid if they report too many things, their loved one’s treatment will be stopped. You will need a great deal of information to be informed and make decisions. Some of this information is complicated, and often it must come from a wide variety of healthcare providers caring for your loved one.

Talking with doctors and nurses to get the information you need:
Sometimes, it can be difficult to get the information you need.

Here are some tips that others have found to be helpful:
• Approach medical staff with the assumption that they want to help you and would like to give you the information you need.
• Buy a notebook and write down all the questions you and your loved one want to ask at the next doctor visit. Writing down your questions beforehand is one of the best ways to be sure you are being clear. If you get flustered, which happens to many people, you can read your questions.
• Help your loved one speak frankly with their healthcare providers. Help them to express them feelings and to let their know them concerns.
• Ask your healthcare provider to repeat anything you and your loved one don’t understand. Repeat it back to make sure you’ve got it right.
• Take notes during the appointment and ask permission to tape record the visit so you can use it as a reminder at home.
• Let the healthcare providers know when your loved one’s needs are not being met.
• Appreciate what the healthcare providers are doing to help your loved one and tell them from time to time.

Important information to tell the doctors and nurses:
Tell them about any problems your loved one is having. Examples:
• Symptoms: Tell them about the symptoms your loved one is having and be specific. How severe is the pain? (Use a 0-10 scale where 0 = don’t have any and 10 = it’s bad as it could be.) How often throughout the day/week do they occur? What makes them worse or better? What are you and they doing for symptom relief? How well do those things work?
• Any problems she has in performing their usual daily activities.
• Financial problems because of your loved one’s treatment.
• Be sure that them healthcare team knows about all the medications, vitamins, supplements, herbal medications, or alternative therapies that your loved one is taking.

What you should know about your loved one’s treatment
People should have all the information they need to provide the best possible care at home. There are many kinds of information that you need:
• An understanding of TOS diagnosis and stage of disease.
• What medicines are involved in your loved one’s treatment.
• Side effects to expect from treatment.
• How to best keep track of treatment and side effects.
• Other treatment that might be available.
• When you should call your doctor or nurse.
• Where you can go to get more information.
• Where you can get support.

Calling the doctor
If you feel the situation is an emergency or urgent and you cannot get the information you need, then call the doctor or an emergency room. To do this, use the word "emergency" in your question, and then be persistent until you have the information you need.

Here are some examples of phrasing you might use:
• "I have an emergency (or urgent need) and need to talk to a doctor."
• "I have a question about ________ and I’m not sure if this is really an emergency. Who can help me?"
• "I’m very concerned about _________. It is urgent."

Improving communication
There are many things you can do to improve your ability to get information you need:
• Be sure you know who you need to reach and how to reach them. If your loved one sees many different doctors, know who you should call for which problems.
• Learn who can answer your questions. Learn which staff members give different kinds of information to people. Example: "Who can tell me when my partner will be discharged?"
• Ask the questions yourself.
• Be sure your statements or questions are phrased clearly.
• Know exactly what information you need. Example:
• "My partner’s pain medication is not effective."
• "My partner’s pain is at level ____." (0 = none to 10 = as bad as it could be)
• Focus your attention on what is most important.
• Say the reason you are concerned.
• Get to your question immediately.
• If you and your loved one have a long list of things to talk about, make a consultation appointment, so the doctor can allow enough time.
• Educate yourself about your loved one’s TOS.
• Learn the routine at their doctor’s office or clinic so you can make the system work for you.
• Accept that all questions do not have answers.
• Try to separate your anger and sense of helplessness about not being able to help your loved one as much as you would like from your feelings about the healthcare team.

Things that can prevent you from getting the information you need
Some people are afraid to ask "stupid questions." This is TOS—there is no such thing as a stupid question. Some people feel that healthcare providers are so important or so busy that they should not take up their valuable time with questions. This is not so! Healthcare providers are there to help people by sharing information and answering questions. If your loved one’s healthcare provider appears very busy, ask: "If this is not a good time, when would be?" Do not feel intimidated. Their role includes answering questions and educating patients and family members. Your loved one has a right to the information.

Think of other obstacles that could interfere with you getting the information you need and make a plan of how you will handle them. Don’t be afraid to encourage your loved one to seek a second opinion, especially during times when she is being asked to share in important treatment decisions. Occasionally, there is a bad match between patients and doctors. If you and your loved one find that communication with the healthcare team is so difficult or unsatisfactory that it is interfering with your loved one’s treatment or well-being, consider switching doctors.

Providing Direct Care to Your Loved One
Providing direct care to a loved one can be difficult and stressful at first. Learning new skills takes time and practice. Taking on tasks that you have not done before such as cooking, lawn maintenance, laundry, or managing the finances can be overwhelming. Most family members agree that the most difficult thing is being able to fit these tasks into their already busy lives.

These are some tips that may help you provide direct care for your loved one at home:
• Make a list of all the healthcare tasks that you need to perform for your loved one.
• Identify tasks that you are willing to perform.
• Circle the tasks that you don’t know how to perform. Ask the doctor or nurse for information and/or training. Have them watch you do the task.
• Talk with your loved one’s doctor or nurse about other providers who may be able to help by performing tasks of care that you are unable or unwilling to perform (visiting nurses, home health aides, Meals On Wheels, chore/housekeeping service, transportation service).
• If you have other people providing care to your loved one, monitor what they are doing so that you know that your loved one’s needs are being met.
• Prioritize the tasks of care that need to be performed.
• Schedule care tasks as much as possible to help you establish a daily routine. Make a list of activities and times.
• Encourage your loved one to do as much for herself/himself as possible.
• Keep a list of signs and symptoms that need to be reported to the doctor or nurse.
• Keep a list of emergency telephone numbers near the telephone (ambulance, hospital, doctor’s office, doctor’s answering service).
• Find a support group for caregivers. Other caregivers will share their experiences with you and can provide tips for providing care.
• Be sure to take care of YOU. This means getting enough rest and exercise, and eating a balanced diet.
• Take time out for yourself each week to go have lunch or dinner with a friend, go to a movie or sporting event, take a walk, or read for pleasure.

If you need more information, the following two books provide very helpful information:
"American Medical Association Guide to Home Caregiving." American Medical Association. New York: Wiley, John & Sons, Inc., 2001.
"Coping: A Practical Guide for People with Life-Challenging Diseases and Their Caregivers." Rubin Battino. Bancyfelin, Carmarthen, UK: Crown House Publishing, 2001.

Taking Care of Yourself When Your Loved One Has TOS
Do you look like you feel? Are tears just under the surface? Are you turning down opportunities to go out for fear of being away from your loved one?

Many friends and family members spend so much time worrying about and caring for their loved one that they forget to take care of themselves. It is critical for you to maintain your own health and well being, because it makes you better equipped to take care of your loved one. Proper diet, adequate sleep, and regular exercise is important for all of us and more so when someone you love has cancer.

The following are suggested strategies for taking care of yourself:
• Participate in physical activity at least three times a week for at least 30 minutes. Exercise promotes better sleep, reduces tension and depression, and increases energy and alertness. If finding time to exercise is a problem, try to incorporate it into your usual day (take the stairs, walk, play with your kids, etc.).
• Get enough sleep so that you feel rested in the morning—try for at least 7 hours every night.
• Eat balanced, nutritious meals (5 servings of fruits and vegetables). Take time to sit down and eat your meals. Do not skip meals.
• Take care of your own physical health (get regular medical check-ups: blood pressure, cholesterol, cancer screening).
• Participate regularly in recreational/leisure activities.
• Drink at least eight glasses of water daily.
• Limit alcoholic beverages. Avoid using alcohol, medications/drugs, or cigarettes to calm your nerves.
• Maintain a healthy weight.
• Set limits to your life. Learn to say NO! Make choices.
• Find a hobby that takes your mind off your worries for a while: fishing, boating, painting, woodworking, knitting, reading, etc.
• Take long, warm baths.
• Look for things to laugh about.
• Get a massage.
• Wear colorful clothes; seize every opportunity to dress more "up" than "down."
• Give yourself permission to take a break from worrying and caregiving.
• Go out for lunch or dinner with a friend or relative.
• Go to the movies, a play, or a concert.
• Find a place to cry and let out the grief and worry.
• Read non-stressful books and magazines.
• Do crosswords, puzzles, jigsaws, garden—anything that diverts your mind.
• Telephone friends; go visit someone you like.
• If possible, stay at work as long as you normally would. Try not to start leaving work or interrupting your work.
• Take long walks and enjoy the sounds, smells, and beauty of nature.

Part of the success of taking a break is ensuring that your loved one is content and cared for in your absence. If you can relax during your time away, then the break will work wonders for you.

Identify Areas Where You Need to Take Better Care of Yourself

Be sure to get enough rest. Your body needs rest to face everyday challenges. As you adjust to life after your loved one’s diagnosis of TOS, your sleep patterns may be disrupted. If you find that you can’t get to sleep or can’t stay asleep, seek out advice from your doctor about what to do.

If you have trouble sleeping try:
• Reading a book before bed may relax you and help you to fall asleep faster.
• Avoid loud noises and turn on slow, relaxing music.
• Avoid alcohol. A few glasses of wine may make you drowsy at first, but it will cause you to be wakeful during the night.
• Avoid caffeine and sugar before bed.
• Try to maintain a regular sleeping schedule.
• Don’t take frequent naps during the day.
• Use your bed only for sleeping (don’t work, watch TV, eat in bed).
• Exercise during the day, but avoid exercising two hours before bed.
• Some prescription drugs can cause sleep problems. Consult your doctor if you think a medication is causing your sleep problem.
• Make your room a good place to sleep: use room-darkening shades and keep it at a steady temperature.

Medical check-ups
Regular check-ups by your doctor, dentist, and optometrist are essential parts of maintaining your health. Visits with such doctors also help in identifying health problems in their early and most treatable stages. Going to the doctor also helps to verify that the positive things that you are doing to help your health are working.

Call your doctor and schedule an appointment. Find out how often you should be going to the doctor, as this changes with age. Write reminders to yourself on your calendar to schedule appointments.

Think of some of the ways that you have taken care of yourself in the past (before your loved one was diagnosed with TOS) and try to start doing them again.

Balancing multiple demands
Many family members need to continue working when their loved one is diagnosed with TOS. This may cause you to experience competing demands and distress. Work is a financial necessity and/or a source of satisfaction for many, yet the responsibilities of caring for and supporting a loved one often conflict with responsibilities at work. People who strive to do both well can feel caught in the middle.

How can I cope with competing demands?
The following tips offer ideas and resources that can help you manage your responsibilities efficiently and balance both work and the caring roles more effectively:
• Look in the personnel manual or other human resources publication to find out your company’s policy on caregivers. Does it offer benefits or services that could help with your situation?
• Talk with your work supervisor about your issues. It is better he/she knows the reasons for your late arrivals or seeming preoccupation rather than draw his or her own conclusions. Before having the conversation, come up with some strategies about how you will cope with absences and time away from work.
• Ask your employer if there is an employee assistance program.
• Ask your Human Resources or Personnel Department to give you information on the Family and Medical Leave Act. (This law entitles eligible workers a maximum of 12 weeks a year of unpaid leave for family caregiving without loss of job security or health benefits.) There are a variety of restrictions, however, such as company size and the amount of time the worker has been employed.
• Take advantage of flex-time policies if that would help your situation.
• Offer to work a less desirable shift or be willing to make up time taken for caregiving by working days or shifts when most people want to be off.
• Check for information and referral resources in your workplace.
• Consider job sharing or working part time if possible.
• Avoid mixing work with time with your loved one. Do your best to avoid interruptions and distractions at work from your loved one’s health issues. If you need to make phone calls or search the internet for information related to your loved one’s needs, do it on a lunch break.
• Manage your time. When you must take time off for caregiving, set priorities and accomplish the most important things first.
• Delegate responsibilities when you can. Pace yourself, as these demands may extend over a prolonged period of time.
• Accept help when you need it. Consider community resources for yourself and your loved one.
• Get all the support you can from family members, friends and community resources.
• Take care of your own needs. Take a break when the pressure gets too great.
• Be sure to thank those at work for the consideration and assistance you receive.

Contact the following organizations for more information:
The Family Caregiver Alliance has information helpful to caregivers. Their website has a resource center that offers practical information:
The AARP website – Caregiving Section:

Time Management
Why time management?
TOS and treatment related activities are often overwhelming and require much time of family members and friends who are juggling multiple roles. It is important that you manage your time wisely, so you can carry out these multiple roles and maintain your own health.

Managing time effectively puts you in control of your life. If you get a handle on how you spend your time, you’ll work smarter, have more time to get things done in your multiple roles, and enjoy life more with less stress.

How do I cope with all the different demands on my time?
These are some tips on how to save time and reduce stress:
• Know how long it takes to complete tasks. Take advantage of small bits of time. Set priorities, delegate, or ask others for help.
• Focus on one task at a time.
• Create a manageable list of things to do each day. Check off tasks as you complete them, so you can see your accomplishments.
• Make a weekly schedule of tasks that need to be done.
• Set realistic goals. Break large tasks into small ones.
• Set and follow priorities. What are your real priorities each day? Make your lists in order of priority and start with the high priority tasks. Often things can be delayed or put off.
• Set aside an hour a day to make phone calls and check e-mail.
• Set aside time each week to do errands.
• Say "no" to things you do not want to do or that are not really necessary.
• Use your high-energy time of day to work on important tasks so that you are in charge of your day.
• Establish routines and stick to them.
• Some time will be spent on things beyond your control. This is just a necessity.
• Delegate what you can to others; you do not need to do everything.
• Ask for help when you need it; accept help when others offer.
• Set time limits for tasks.
• Don’t waste waiting time. Use that time.
• Some time each day must be spent for you.

Access the following sites for more information:
• Family Caregiving 101: Time Management

Recognizing When You’re Stressed Out
Too much stress can lead to more serious health problems. Learn to recognize signs of stress in yourself, and contact your healthcare provider if you experience the following on a regular basis:
• Denial about the disease and its effect on your family member.
• Anger at your loved one.
• Social withdrawal from friends and activities that once brought you pleasure.
• Anxiety about facing each day and the future
• Depression and feeling unable to cope.
• Exhaustion making it impossible to complete necessary tasks of the day.
• Sleeplessness caused by constant concern and worry.
• Irritability that triggers negative responses and reactions in others.
• Lack of concentration making it difficult to perform usual daily tasks.
• Health problems which take their toll, both mentally and physically—worsening chronic disease, colds.
• Managing Anxiety

What is anxiety?
Anxiety is a vague feeling of uneasiness, unpleasant feelings, or fear resulting from expecting some bad news or harm. Anxiety can happen to anyone, but family members and friends facing the serious illness of a loved one may get anxious more easily than others. Anxiety and fear are common and normal feelings when coping with a diagnosis of TOS.

Recognizing anxiety
People who have anxiety say they feel uneasy, tense, apprehensive, wary, or agitated. They have a feeling of restlessness and uncertainty, and they are fearful or have a sense of dread or impending doom. People tremble, sweat, have rapid breathing, have a rapid heart rate, or can feel their hearts pounding in their chests. In addition, some people experience shakiness or difficulty falling asleep. Sometimes people may become overly fearful and may no longer cope well with their day-to-day lives.

Coping with anxiety
No two people experience anxiety in the same way. These are tips other people have found helpful:
• Try to identify what "triggers" your anxiety.
• List coping strategies that have helped you in the past.
• Talk with others, such as in a support group, about your anxiety.
• Increase pleasurable, distracting activities such as listening to your favorite music.
• Use relaxation techniques such as controlled breathing or guided imagery (picture a pleasant scene in your mind).
• Be around others as much as possible, if this is relaxing.
• Use prayer or other types of spiritual support, such as meditation.
• Talk with your doctor or nurse about prescribing medicine to help reduce your anxiety.
• Use relaxation tapes.
• Express feelings and concerns to others.
• Limit your caffeine intake by decreasing your intake of coffee, caffeinated colas, tea, and chocolate.
• Ask your doctor for a counseling referral if these tips are not helpful.

Family members and friends can help you with anxiety
• Have family members and friends help you with relaxation exercises such as deep breathing or visualizing pleasant scenery.
• Ask family members and friends to help you with situations or chores that you’ve identified as stressful.
• Ask family members and friends to bring home books from the library or bookstore about teaching relaxation exercises or imagery.

Talking with others about your anxiety
• Be open and honest about your feelings and concerns with your family members.
• Try to describe your feelings when you’re experiencing them (racing thoughts, lump in your throat, nausea, shortness of breath, dizzy or scared, etc.).
• Ask your family members and friends how your anxiety is affecting them.

Call your doctor or nurse if you experience any of the following problems:
• Panic attacks.
• Problems with anxiety that last beyond 2 weeks.
• Persistent fearfulness.
• Shortness of breath that lasts beyond 2 weeks.
• Shakiness, agitation or restlessness that lasts beyond 2 weeks.
• Heart racing and beating hard.
• Excessive sweating.
• Persistent problems sleeping or getting to sleep.
• No relief after trying suggestions.

Managing Depression and Sadness
What is depression and sadness?
Depression is sadness that happens in response to an event or due to changes in your body chemistry. Depression is sadness that is greater than normal, lasts two weeks or more, and greatly impacts your daily life.

Recognizing depression and sadness
People describe depression as the darkest times in their lives. Many people report crying spells, or problems with sleep (either sleeping all day or not sleeping enough). Others describe problems with eating (too much or not enough), feeling hopeless, helpless, worthless, or even feeling like they want to hurt themselves. People may have trouble experiencing any pleasure or interest in daily life, and they may not want to talk to family or friends.
Depression is not the same as an occasional, short-lived period of sadness. In depression, these low feelings are severe and stay for two or more weeks.

The causes of depression and sadness
Depression can occur as a result of specific events, such as a loved one being diagnosed with TOS. It can also be caused by medications or fatigue or from chemical changes in the brain. Generally, most people can cope with short-term feelings of depression. Persistent depression (greater than two weeks) should be evaluated by a healthcare provider for possible counseling and/or medication.

Coping with depression and sadness
Every person uses different approaches when they are depressed and sad. These are some tips other people have found helpful:
• Try controlled breathing and relaxation exercises; these help release mood-enhancing substances from the brain.
• Express your feelings through journal writing or creative expression (dance, cooking, exercise, painting or music).
• Avoid alcohol consumption; it can make you feel more depressed.
• Try to get enough sleep at night; avoid napping during the day.
• Try to identify something that brings you pleasure every day.
• Be with other people as much as possible, if this helps you relax.
• Participate in regular, routine exercise. Exercise has been shown to improve mood and well-being.
• Make an appointment with your doctor and tell him/them exactly how you feel and that you need help.
• Make a list of all the medications you take; show this to your doctor or nurse. Some medicines may have to be stopped or changed.
• Join a support group. This can help relieve the isolation that is often felt by those who are depressed.


“TOSS” Thoracic Outlet Syndrome Society, Inc.
A Nonprofit Organization to Support T.O.S. Patients