Psychosocial Issues of Breast Cancer Survivorship
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From Medscape Hematology-Oncology
Talking With Your Patients About Cancer
Psychosocial Issues of Breast Cancer Survivorship
Posted 01/16/2009
James L. Khatcheressian, MD; Susan E. Brown, MS, RN
Author Information
Editor's Note:
Patients with breast cancer face both medical and psychosocial challenges before, during, and after cancer treatment. Psychosocial issues are often related to daily family life, finances, relationships, self-esteem, and sexual identity. Dr. James Khatcheressian, of the VCU Massey Cancer Center and the Virginia Cancer Institute, both in Richmond, Virginia, discusses psychosocial issues of breast cancer survivorship in an interview with Susan E. Brown, MS, RN, Director, Health Education, Susan G. Komen for the Cure. In this interview, Dr. Khatcheressian explains how to identify depression, when to refer for psychiatric consultation, and how to provide comprehensive follow-up for breast cancer survivors.
Susan Brown: Dr. Khatcheressian, how would you define psychosocial issues that patients with breast cancer face?
Dr. Khatcheressian: Generally, psychosocial issues tend to be those issues that are outside of the patient's immediate medical concerns. Examples of psychosocial issues could be ongoing financial issues or other types of stressors within the patient's social or family environment that also may increase anxiety. These could be concurrent medical issues with other family members or logistic issues with treatment. They could be concerns about health insurance or concerns about missing too much work because of the needs of some type of adjuvant or palliative treatment.
Susan Brown: What are the most common psychosocial issues that you see in your patients relative to treatment?
Dr. Khatcheressian: There are 2 common psychosocial issues that breast cancer patients face. One is how the cancer diagnosis and treatment are going to affect the patient's immediate family, such as spouse and children. In most families, women tend to be the primary caregivers, so, of course, all of those responsibilities rest on their shoulders. And number 2 would be how the diagnosis and treatment affect that woman's own identity as a woman. That's one of the things that makes breast cancer a little unique, in that it involves surgery and chemotherapy and radiation therapy. A lot of that can affect a woman's sexual identity and affect her view of herself even within the marital relationship. In particular, young married patients will often run into marital problems, sometimes as a result of the diagnosis, and, of course, this can have long-lasting implications as well.
Susan Brown: Are there certain tools, assessment methods, or screening tests that you use to try to identify those patients who may be struggling with esteem issues?
Dr. Khatcheressian: Well, some of the most straightforward and commonsense approaches include asking a patient such questions as, "Are there any problems within your life that I need to know about as we go ahead with our treatment?" "How are your kids dealing with your diagnosis?" "How is your relationship with your spouse?" "Does your family have questions?" One of the main things I try to do throughout the course of treatment, whether it be adjuvant or palliative, is some general screening for anxiety and depression. I find that the simpler the tool, the easier it is to administer. Specifically with depression, I ask 2 questions. One is directly asking a woman, "Are you depressed or do you feel depressed most of the time?" And if she responds in the affirmative to that, then I follow up with "Are you finding it difficult to find joy in the things that you used to find joy in?" And that could include anything from the very simple pleasures in life to interest in their hobbies and their other interests. Those 2 screening questions tend to help most with regard to identifying depression. And, of course, if the answers are in the affirmative I try to deal with that immediately and then make a deeper assessment about whether to involve a psychiatry colleague. With respect to the severity of depression, if someone really does have any kind of suicidal ideation, that clearly requires much more urgent intervention. But, if a woman says that she feels depressed and is not getting out of the house as much as she used to, then we talk about that a little further and try to start some type of antidepressant medication.
Anxiety is the other issue, and some of that is appropriate. Many breast cancer patients say that, after their adjuvant treatment, any minor physical ailment (such as a cough or headache) will concern them as a first sign of recurrence. I think that is a natural reaction for many people, and that's okay because they're trying to be vigilant. But if their concerns about potential recurrence affect sleep, ability to work, or to interact with their loved ones, then clearly some type of intervention is needed to help them get back to a more normal level of functioning.
Susan Brown: Are there certain characteristics that place a patient at higher risk for these issues? Is there something special about the type of breast cancer they have, the stage, or certain treatments that put them at higher risk?
Dr. Khatcheressian: There are probably a few things that place a woman with breast cancer at higher risk for depression or anxiety. Because breast cancer gets so much press, that by itself probably heightens anxiety. There is just so much information out there about breast cancer. I recommend that patients stick to 1 or 2 Websites that I give them for patient-oriented information.
The type of social support system a woman has is very important. This includes whether she is in a happy, stable relationship, or whether her marriage is strong and whether she has a good amount of support from friends and family to help with any childcare needs, such as taking kids to school or all of those other daily issues in life. I think good social support can minimize or prevent those psychosocial stressors. Because, if you think about it, it's stressful enough to receive a diagnosis of breast cancer, worry about that cancer taking your life, and then worry about how that would affect your children. Then, there are concerns about having to actually go through the treatments and suffer the side effects of that therapy. On top of all that, the patient is just trying to keep everything straight in her life.
Susan Brown: Patients often tell us that social support diminishes after treatment ends, and that family and friends expect things to go back to normal. So often these survivors tell us that things don't really go back to normal, that they often achieve a "new normal," but that they are somehow changed. Is the time after treatment is completed when people are more vulnerable, or do you find that this vulnerability occurs earlier on, closer to the time of diagnosis?
Dr. Khatcheressian: I always tell my patients, especially the ones who have gotten through their treatment without any major stumbling blocks, that the hardest part of treatment, in my opinion, is at 1-6 months after the treatment has ended. I completely agree that that is a more stressful time for patients, for several reasons. One is that when a patient is preparing for chemotherapy, radiation therapy, and surgery, she tends to fortify herself and to build up her defenses. But once the treatment is finished, there's an emotional release of all the tension and anxiety held back during treatment. I find that patients often feel depressed, have a lot of crying spells, anxiety, and trouble with sleep, during those several months after treatment is completed. I try to prepare my patients for that, telling them that that is a very normal reaction. I offer antidepressant medication, but I try not to give them a lot of those long-term medications because it's such a normal response. There's nothing wrong with them. I do try to take care of some of the shorter-term problems, like insomnia. I can at least do something about that, and if they can get a good night's sleep, that helps with the coping and recovery processes. A lot of times patients do not ever feel like they'll go back to normal, and that is also, in my opinion, a very normal and healthy response. If a woman said that she went right back to normal and had no other concerns about her breast cancer recurring, then that would actually be a bit of a cause for concern on my part, because I would be afraid that she was in denial about her diagnosis. There certainly is a risk for recurrence and there is the need to be vigilant, so a woman who has been treated for breast cancer achieves a new type of normal. I think our job as physicians is to make that transition to that new normal as easy as possible and to help with that new stage in life where they become breast cancer survivors.
Various centers have survivorship clinics now. A lot of the community breast cancer specialists try to focus their breast cancer surveillance on that bigger notion of survivorship care, which is not just concerned about following the ASCO (American Society of Clinical Oncology) guidelines on breast cancer surveillance about symptoms, but, rather, to address all of those other areas, like bone health, depression, anxiety, lymphedema, and hot flashes. Many of those other side effects can be successfully treated. The endocrine therapies, for example, are associated with side effects such as hot flashes, vaginal dryness, or decreased libido that can certainly contribute to decreased quality of life. We really do try to address all of those things because survivorship care is not just about monitoring for breast cancer recurrence; it involves trying to treat the patient as a whole.
Susan Brown: You mentioned insomnia and depression. What about fatigue? It's my understanding that a fair number of patients report fatigue many years after the completion of treatment. What are your thoughts about that?
Dr. Khatcheressian: Yes, there are a number of causes for fatigue in breast cancer patients. The most common is, of course, side effects of therapy. For example, women can experience fatigue from antiestrogen agents such as tamoxifen or one of the aromatase inhibitors. I think a significant number of women who experience fatigue are in that group and, unfortunately, there isn't much you can do about that. There are various trials looking at agents such as methylphenidate, but they tend to be helpful in a minority of patients. I will prescribe it every now and then, but the success rate is 20% or less. The other concern with respect to chronic fatigue is that it may be a presenting symptom for an underlying depressive or anxiety disorder -- assuming there aren't other severe adverse effects of therapy, such as leukemia, myelodysplasia, or congestive heart failure. Many patients have long-term problems with chemotherapy. You've probably heard of "chemo brain." We don't have a definite etiology for what causes this condition, but that could also contribute to the fatigue complaints that we encounter.
A very interesting study on monozygotic twins was published by Ferguson and colleagues[1] in the Journal of Clinical Oncology. One twin had a history of breast cancer treated with chemotherapy and self-reported cognitive dysfunction -- despite little objective difference in neuropsychological testing, compared with her sister. However, functional MRI brain imaging revealed significantly more white matter uptake in the sister who had received chemotherapy, suggesting that she had to activate more neural pathways to accomplish the same cognitive tasks as her twin. Unfortunately, we do not know how to treat "chemo brain," but a number of ongoing studies are investigating this distressing side effect.
Susan Brown: You mentioned lymphedema earlier. How often do you see that? And how do you manage it?
Dr. Khatcheressian: Thankfully we're seeing a lot less lymphedema now than we did 10 or 15 years ago because fewer women are receiving complete axillary node dissections. In the literature, the rate of lymphedema varies, and it varies by institution. Generally, we quote a rate of about 10% to about 20% of lymphedema for women who receive a complete axillary node dissection. But, many more women are simply undergoing sentinel node biopsy, obviating the need for a complete node dissection.
When patients develop lymphedema, it is not reversible. We do try to catch it as early as possible to make referrals for physical therapy and lymphedema management. We tell patients who have had an axillary node dissection about reducing their risk of developing lymphedema by not having any blood draws or use of a blood pressure cuff on the arm that was on the same side as the node dissection, being very vigilant about even minor skin infections.
Susan Brown: You mentioned survivorship clinics. What is their availability, and how are they typically staffed?
Dr. Khatcheressian: The only one I can speak of directly is the Massey Cancer Center Adult Cancer Survivorship Clinic, directed by Dr. Alton Hart. They tend to see patients who are at least 5 years out from their diagnosis. And my understanding is that they try to do all of the standard breast cancer surveillance care, as well as address the side effects of treatment. Their focus has more to do with the psychosocial issues affecting long-term survivors, such as what their anxiety levels are and how much their concern about recurrence affects their daily lives. It's a fairly new clinic, so they're trying to collect some data because there are obviously a lot of unanswered questions. Before I left Massey Cancer Center, I developed a portable USB thumb drive tool[2] for breast cancer survivors, which is probably completing its pilot phase at this point. We're gathering data on it. Rather than relying so much on the survivorship clinic, we were trying to put more of the information into the hands of breast cancer patients. The real impetus for the study were data from a 2006 ASCO workforce study[3] that estimated an almost 50% increase in the need for oncology services in the United States between 2005 and 2020. On the other hand, oncology services were only projected to increase by about 14%. To make up for this gap between need vs availability of medical services, cancer patients will have to be more actively involved in their own care.
Breast cancer patients seem uniquely suited to a portable electronic tool that helps them with their survivorship issues because, number 1, breast cancer recurrences can occur at 15 years and beyond. So, they certainly need long-term follow-up care. And, number 2, breast cancer patients tend to be a lot more involved in their own care. They're all over the Internet. They're always bringing in a report of a study that deals with either treatment or survivorship issues. They're very savvy about the relevant medical issues, so we figured that a tool like this would simply empower them to do what they're already doing.
I had a number of my breast cancer patients come to me from the Massey Cancer Center and many of them were in this study. I would ask them, "When did you see your surgeon last?" or "When did you see your radiation oncologist last?" And they would say, "I don't remember, but it's on my key [the USB tool]." So, they'd pull the key out and plug it into my computer. Then I could see every single note from her surgeon, her radiation oncologist, her mammogram reports, previous labs, her pathology -- just about everything. It's something we're just not really used to seeing in the community. Hopefully the technology will allow us to continue doing that in the future.
Susan Brown: So what do you see as the role of education and counseling, including support groups and individual and psychological counseling?
Dr. Khatcheressian: As far as education goes, support groups will always be there and they're fantastic. They need to be run locally because I think that generally breast cancer survivors still like face-to-face support groups instead of online support groups. Our local hospital runs those. Of course, Susan G. Komen for the Cure has a good network of support groups as well, through grants made to local organizations by local affiliates.
The area that can be improved the most is how to educate patients better when they are survivors. When you look at the quality of cancer care in this country, it is generally very good, but there is a lot of variability. The ability of physicians, including primary care practitioners, to diagnose a recurrence is very good. But the quality of supportive care for survivors is really all over the place. I am referring to how well physicians treat hot flashes, how vigilant they are about referring patients for lymphedema, how well they address bone health issues, and all of the other survivorship issues that survivors cope with. I don't think patients always know what resources are available to them or what they should expect can be done. A lot of my older patients accept hot flashes from their hormone therapy as a given and think they just need to grin and bear it, but, in fact, there is quite a bit physicians can do to alleviate them. I make it a point to ask about those issues that can be addressed, but other physicians may not be as vigilant. Patient education is key because breast cancer survivors need to be empowered to seek better care, especially for the next 10 years or so as we experience even greater stress on our healthcare infrastructure.
Susan Brown: It sounds like there are a lot of topics to be covered when following breast cancer patients. How do you meet that demand in your busy practice?
Dr. Khatcheressian: I go over a checklist with my patients. "Are you having hot flashes? Are you having problems with chronic fatigue? Any problems with anxiety or depression? When was your last bone scan? When was the last time we checked a vitamin D level?" We address lymphedema if she had an axillary node dissection and it is relevant. I address those topics, which represent about 75% of what most patients need, at every visit. Then there are other things, like lingering neuropathy issues, that we would address if relevant.
The typical breast cancer patient in this setting is usually postmenopausal and estrogen-receptor positive, so she may or may not have had chemotherapy. Hopefully, she has had a lumpectomy and radiation therapy, and then she's seeing me during her regular follow-up visit. So we always talk about symptoms of recurrence, whether there's anything physically that she's noticed that is abnormal for her. My threshold for being concerned about something is 2 weeks. If a woman has had a cough for longer than 2 weeks, for example, then I'm going to look into it and I'm not going to chalk it up to just a typical upper respiratory infection.
Susan Brown: What would you want other community physicians to know about your checklist and how to follow these patients?
Dr. Khatcheressian: Electronic medical records make the checklist a lot easier. Within our electronic medical record I have a standard breast cancer follow-up template where, in my impression and plan section, I simply list all of the things that I already enumerated. Since I do this all the time, it's just second nature for me to go through hot flashes and bone health and vitamin D levels and libido issues and anxiety and depression issues, but for providers who don't see quite as many breast cancer patients, I think some kind of standardized format is most helpful, as well as a general algorithm to follow. And in many cases, especially when nurse practitioners or RNs are available, having an algorithm for common symptoms (such as an SSRI [selective serotonin reuptake inhibitor] for hot flashes) can be very helpful.
Susan Brown: Do you have any concluding thoughts?
Dr. Khatcheressian: In my practice every woman with a new diagnosis for breast cancer gets a 1-page summary sheet of everything she needs to know about surgery, radiation, chemotherapy, and endocrine therapy. This is because quality and consistency of cancer care, especially breast cancer care in this country, is quite variable and because breast cancer is always managed in a very multidisciplinary fashion. There is always a surgeon, a radiation oncologist, and a medical oncologist involved, possibly a plastic surgeon, and obviously a radiologist, as well. Some communities, like ours, have a multidisciplinary breast cancer clinic. The problem is that patients still see a variety of doctors and every doctor addresses his or her own particular area -- but no one consolidates that information for patients. So my 1-page handout describes diagnosis, stage, the various treatment options available, what we're going to do, and why we're going to do it. For example, "do you need radiation?" Yes. Why are you getting radiation? "To prevent local recurrence," for example. "Why are you getting chemotherapy?" To prevent distant disease recurrence. "What is the chance that chemotherapy is going to benefit you?" There is, for example, an 8 out of 100 chance that it will benefit you in this setting, and this is the chemotherapy regimen we would use. "What are the side effects of treatment? What does treatment involve?" An IV, a portacath, lab work every few weeks, white blood cell growth factor support, etc. All of that goes onto 1 page and becomes the patient's guide through this journey of her treatment. I think that is definitely not done in the community, but I think patients do appreciate it and I think it is genuinely helpful to them.
The last issue I'd like to discuss is where patients should get information about cancer or survivorship issues. I always refer patients to 3 Websites: the American Society of Clinical Oncology (www.cancer.net), the American Cancer Society (www.cancer.org), and Susan G. Komen for the Cure (www.komen.org) because they're all easy to understand and navigate.
This activity is supported by an independent educational grant from Susan G. Komen for the Cure.
Comments
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WOW
I read every word of that, and it certainly made sense to me. I am depressed, in pain and uncertain about the future. Yet my so called "Better Half" Bangs on about my lack of sex drive EVERY DAY! He's driving me mad! Is it normal for couples to have a 'Routine'?.......One day on, one day off?.......I am on tamoxifen and spend all night pouring with sweat and sleeping on a bath towel, then I wake up (Get woken up) in the morning by Amourous Man No:1.........and break out into a major sweat again, anxiety attack. I don't think he even notices, he's too busy thinking about HIS needs and wants. Is it my fault, all this?.....Please give me the truth, I can't afford a therapist. Hugs Jxxxxxxxxx0 -
Are you serious!!!tasha_111 said:WOW
I read every word of that, and it certainly made sense to me. I am depressed, in pain and uncertain about the future. Yet my so called "Better Half" Bangs on about my lack of sex drive EVERY DAY! He's driving me mad! Is it normal for couples to have a 'Routine'?.......One day on, one day off?.......I am on tamoxifen and spend all night pouring with sweat and sleeping on a bath towel, then I wake up (Get woken up) in the morning by Amourous Man No:1.........and break out into a major sweat again, anxiety attack. I don't think he even notices, he's too busy thinking about HIS needs and wants. Is it my fault, all this?.....Please give me the truth, I can't afford a therapist. Hugs Jxxxxxxxxx
Oh Tasha, it is soooooo not your fault. I think that sex drive is one of the first things to go when depressed. You know what they say about drugs....."Just say no". He may look confused at first but he'll catch on.
Only you know if he can be educated about what you're going through. There's tons of info out there about the emotional aspects of this and how it affects our sexuality that he could look at. Maybe try that?? Is that you laughing?? I think I know what you're dealing with or at least, much of how you portray your relationship reminds me someone I was with years ago and I really feel for you.
Tasha, I don't know if it's been mentioned before or if you're already doing it but try splitting your tamoxifen in half and take half in the am and half at night. This really helped me with my depression.
Good luck to you
love
jan0 -
Split tamoxifen?phoenixrising said:Are you serious!!!
Oh Tasha, it is soooooo not your fault. I think that sex drive is one of the first things to go when depressed. You know what they say about drugs....."Just say no". He may look confused at first but he'll catch on.
Only you know if he can be educated about what you're going through. There's tons of info out there about the emotional aspects of this and how it affects our sexuality that he could look at. Maybe try that?? Is that you laughing?? I think I know what you're dealing with or at least, much of how you portray your relationship reminds me someone I was with years ago and I really feel for you.
Tasha, I don't know if it's been mentioned before or if you're already doing it but try splitting your tamoxifen in half and take half in the am and half at night. This really helped me with my depression.
Good luck to you
love
jan
Why did you do that? I am going on it in a couple of months. thanks0 -
You might be fine on theJeanne D said:Split tamoxifen?
Why did you do that? I am going on it in a couple of months. thanks
You might be fine on the 20mg/day taken all at once but I became deeply depressed at some point while on it and when I split the tab and took 10mg in the morn and 10mg at night my depression lifted within a couple of days. Not everyone has this problem but I did and it helped me.
love
jan0 -
My oncologist gave me 10 mgphoenixrising said:Are you serious!!!
Oh Tasha, it is soooooo not your fault. I think that sex drive is one of the first things to go when depressed. You know what they say about drugs....."Just say no". He may look confused at first but he'll catch on.
Only you know if he can be educated about what you're going through. There's tons of info out there about the emotional aspects of this and how it affects our sexuality that he could look at. Maybe try that?? Is that you laughing?? I think I know what you're dealing with or at least, much of how you portray your relationship reminds me someone I was with years ago and I really feel for you.
Tasha, I don't know if it's been mentioned before or if you're already doing it but try splitting your tamoxifen in half and take half in the am and half at night. This really helped me with my depression.
Good luck to you
love
jan
My oncologist gave me 10 mg of tamoxifen twice a day from the get to because in his experience the majority of the women he treated became depressed. Lili0 -
I wish all oncs were as wisemmontero38 said:My oncologist gave me 10 mg
My oncologist gave me 10 mg of tamoxifen twice a day from the get to because in his experience the majority of the women he treated became depressed. Lili
I wish all oncs were as wise as yours Lili. There are so many women that put up with depression as well as other se on tam and then they become discouraged and don't want to continue. None of my docs mentioned the lower dose but I hope now they use that info to help others.0 -
Thank you!...
for sharing this info. This is absolutely the best and most inclusive article I have ever read all in one place. I SO wish this guy had been my doctor!
My cancer issues and treatment ran from 1986 to 2001 and NEVER during all that time did any of my medical 'people' even try to address the psychosocial issues I was dealing with. Not depression, side effects (beyond my oncologist giving me ativan and telling me to 'sleep it off'), bone issues, family issues (I lost my husband to cancer; I got cancer and he got lost)... nothing.
It has only been in the last 3 years since I have been on this site that I have learned what I SHOULD have done and had done for me. But at least now I am better aware and equipped to handle some of the ongoing and life-long effects that still linger in my life.
Thanks again, hun. You have done your good deed for the day...maybe for a whole week! LOL0 -
great article
As someone on the front end of this journey it is encouraging to read that a. I have a good chance of making it through, b. knowing what I might find up the road helps me to prepare myself and my family, c. there is a sense of comfort in knowing that there is so much known because at times it feels so much like the WHY is a black void, so I am finding some solace in the WHAT MIGHT BE NEXT.
I was intrigued by the statement the doc made about the time period after treatments...
Also as for amourous man #1, my first thought was throw him the towel you've been sleeping on, wish him good luck and roll over. Prior to bc I was having huge hot flashes. My husband is a martial artist and at 54 doing constant somersaults with the younger students, coming home with a very sore shoulder. Whenever I had a hot flash he would get very cuddly...I realized it wasn't my raging hormones that attracted him, he said he just needed to get some heat off of me. Now this is normally a very sensitive, helpful, patient, tolerant man...but you know I just didn't want to feel like a hot water bottle, the steam coming out of the top of my head was not an invitation to save the steps to the tylenol nor did it mean there was a new pope... The last time I was steaming away and he asked if I could just lay my arm over his shoulder, I got up and filled a glass of ice water from the fridge, poured it on his shoulder (about 2am) and told him I think it would be better to ice it first...again that was the last time I was his built in heating pad...
but again he remains my faithful loving caring fun partner...just needed a thunk.
jojo0 -
Jan, what a great article.phoenixrising said:I wish all oncs were as wise
I wish all oncs were as wise as yours Lili. There are so many women that put up with depression as well as other se on tam and then they become discouraged and don't want to continue. None of my docs mentioned the lower dose but I hope now they use that info to help others.
Jan, what a great article. It addressed so many issues we all have going down this unwanted journey. I copied it and pasted it to a document on my desk top for easy reference. I will be giving this article to others that are diagnosed with bc. Thanks and hugs, Lili0 -
You know Zahalene, I waszahalene said:Thank you!...
for sharing this info. This is absolutely the best and most inclusive article I have ever read all in one place. I SO wish this guy had been my doctor!
My cancer issues and treatment ran from 1986 to 2001 and NEVER during all that time did any of my medical 'people' even try to address the psychosocial issues I was dealing with. Not depression, side effects (beyond my oncologist giving me ativan and telling me to 'sleep it off'), bone issues, family issues (I lost my husband to cancer; I got cancer and he got lost)... nothing.
It has only been in the last 3 years since I have been on this site that I have learned what I SHOULD have done and had done for me. But at least now I am better aware and equipped to handle some of the ongoing and life-long effects that still linger in my life.
Thanks again, hun. You have done your good deed for the day...maybe for a whole week! LOL
You know Zahalene, I was thinking of those like yourself who had to go through it alone. When we didn't have internet and couldn't connect and share our experiences and hoped our friends/family understood. Even the words "psychosocial issues" probably were a "brave new world term". There was very little info out there concerning the ongoing problems we can have.
It must have been very hard, but geez girl, look at you now. A strong warrior that has so much wisdom and compassion to give to us newbies. We thank you
love
jan0 -
I am so glad you found thejojo elizapest said:great article
As someone on the front end of this journey it is encouraging to read that a. I have a good chance of making it through, b. knowing what I might find up the road helps me to prepare myself and my family, c. there is a sense of comfort in knowing that there is so much known because at times it feels so much like the WHY is a black void, so I am finding some solace in the WHAT MIGHT BE NEXT.
I was intrigued by the statement the doc made about the time period after treatments...
Also as for amourous man #1, my first thought was throw him the towel you've been sleeping on, wish him good luck and roll over. Prior to bc I was having huge hot flashes. My husband is a martial artist and at 54 doing constant somersaults with the younger students, coming home with a very sore shoulder. Whenever I had a hot flash he would get very cuddly...I realized it wasn't my raging hormones that attracted him, he said he just needed to get some heat off of me. Now this is normally a very sensitive, helpful, patient, tolerant man...but you know I just didn't want to feel like a hot water bottle, the steam coming out of the top of my head was not an invitation to save the steps to the tylenol nor did it mean there was a new pope... The last time I was steaming away and he asked if I could just lay my arm over his shoulder, I got up and filled a glass of ice water from the fridge, poured it on his shoulder (about 2am) and told him I think it would be better to ice it first...again that was the last time I was his built in heating pad...
but again he remains my faithful loving caring fun partner...just needed a thunk.
jojo
I am so glad you found the article useful. You know you are one funny lady! And I can't believe you really poured ice water on your husbands shoulder at 2am. I couldn't do that....cause I know he'd get me back twice as much when I'm not expecting it.
love
jan0 -
I'm glad you enjoyed themmontero38 said:Jan, what a great article.
Jan, what a great article. It addressed so many issues we all have going down this unwanted journey. I copied it and pasted it to a document on my desk top for easy reference. I will be giving this article to others that are diagnosed with bc. Thanks and hugs, Lili
I'm glad you enjoyed the article. You know I was wondering if it would be useful for other cancer pts as well. We all have many of the same issues.
love
jan0 -
I don't think I have everjojo elizapest said:great article
As someone on the front end of this journey it is encouraging to read that a. I have a good chance of making it through, b. knowing what I might find up the road helps me to prepare myself and my family, c. there is a sense of comfort in knowing that there is so much known because at times it feels so much like the WHY is a black void, so I am finding some solace in the WHAT MIGHT BE NEXT.
I was intrigued by the statement the doc made about the time period after treatments...
Also as for amourous man #1, my first thought was throw him the towel you've been sleeping on, wish him good luck and roll over. Prior to bc I was having huge hot flashes. My husband is a martial artist and at 54 doing constant somersaults with the younger students, coming home with a very sore shoulder. Whenever I had a hot flash he would get very cuddly...I realized it wasn't my raging hormones that attracted him, he said he just needed to get some heat off of me. Now this is normally a very sensitive, helpful, patient, tolerant man...but you know I just didn't want to feel like a hot water bottle, the steam coming out of the top of my head was not an invitation to save the steps to the tylenol nor did it mean there was a new pope... The last time I was steaming away and he asked if I could just lay my arm over his shoulder, I got up and filled a glass of ice water from the fridge, poured it on his shoulder (about 2am) and told him I think it would be better to ice it first...again that was the last time I was his built in heating pad...
but again he remains my faithful loving caring fun partner...just needed a thunk.
jojo
I don't think I have ever used the word guffaw outloud before, but reading that post left me guffawing! Thanks for the deep down laugh. Your husband is a lucky man to live with such a "warm" sense of humor in his wife.
love, Joyce0 -
Great article
What a great article. I've cut 'n pasted it into a Word document and already sent it off to several people. Dare I give a copy to my doctor? Which one? I'm new at this, diagnosised Feb 4, 2009, and I have a team--surgery oncologist, plastic surgeon, and a medical oncologist that I'll meet for the first time on Thursdy this week.
I'm still not sure how much support I'm going to need. I am (stupidly??) not worrying about dying from breast cancer, but worried about traveling the road that I'm on.
Any suggestions would be welcome.
Lisa0 -
Oh, Jan, you are too kind.phoenixrising said:You know Zahalene, I was
You know Zahalene, I was thinking of those like yourself who had to go through it alone. When we didn't have internet and couldn't connect and share our experiences and hoped our friends/family understood. Even the words "psychosocial issues" probably were a "brave new world term". There was very little info out there concerning the ongoing problems we can have.
It must have been very hard, but geez girl, look at you now. A strong warrior that has so much wisdom and compassion to give to us newbies. We thank you
love
jan
Oh, Jan, you are too kind. But really if we don't help each other what is the point? I really believe that passing on what we learn in the rough spots of life is what it is all about.0 -
Lisa, you are not beingLtalcott said:Great article
What a great article. I've cut 'n pasted it into a Word document and already sent it off to several people. Dare I give a copy to my doctor? Which one? I'm new at this, diagnosised Feb 4, 2009, and I have a team--surgery oncologist, plastic surgeon, and a medical oncologist that I'll meet for the first time on Thursdy this week.
I'm still not sure how much support I'm going to need. I am (stupidly??) not worrying about dying from breast cancer, but worried about traveling the road that I'm on.
Any suggestions would be welcome.
Lisa
Lisa, you are not being stupid, but wise to face each step as it comes and not get bogged down in the 'what ifs' down the road. You need your available energy to deal with whatever treatment plan is ahead and useless worry just drains us of valuable resources.
I'd say give this document to EVERYBODY even remotely concerned with your situation....doctors, family, friends, whoever. They may or may not read it and even if they do they may or may not 'get it' all, but at least you have given them a great tool to be what and who you may need them to be to you in the future.
God Bless.0 -
Lisa.........same hereLtalcott said:Great article
What a great article. I've cut 'n pasted it into a Word document and already sent it off to several people. Dare I give a copy to my doctor? Which one? I'm new at this, diagnosised Feb 4, 2009, and I have a team--surgery oncologist, plastic surgeon, and a medical oncologist that I'll meet for the first time on Thursdy this week.
I'm still not sure how much support I'm going to need. I am (stupidly??) not worrying about dying from breast cancer, but worried about traveling the road that I'm on.
Any suggestions would be welcome.
Lisa
Hi, sorry you had to find us (Blimey, I sound like Nosferatu in his darkest mood) I was less blown away by the diagnosis of Breast Cancer than I was by the treatment ahead of me.. In this we are probably the same, I freaked when my Oncologist (Dr. Charisma-Bypass) told me that I had 5 months of treatment ahead and I was going to be bald.......WOW, What a charmer eh? I think it is normal to be thinking as you are, not stupid at all. I didn't decide to undergo chemo until the night before it was due, the treatment seemed far worse than the disease, BUT.. It didn't pan out that way at all, The treatment was tolerable, much easier than I would ever have imagined (and all this from the worlds No:1 Coward).. You will be fine, this will all be behind you before you can blink! And so will the BC. I wish you well. Take Care Jxxxxxx0 -
Lisa, I'm glad you got soLtalcott said:Great article
What a great article. I've cut 'n pasted it into a Word document and already sent it off to several people. Dare I give a copy to my doctor? Which one? I'm new at this, diagnosised Feb 4, 2009, and I have a team--surgery oncologist, plastic surgeon, and a medical oncologist that I'll meet for the first time on Thursdy this week.
I'm still not sure how much support I'm going to need. I am (stupidly??) not worrying about dying from breast cancer, but worried about traveling the road that I'm on.
Any suggestions would be welcome.
Lisa
Lisa, I'm glad you got so much out of the article. This is a big week for you with lots of info and decisions to make. The ladies and gents here are full of wisdom, so run your itinerary past them once you know what you'll be needing. We may not be able to help you physically but we certainly can help you emotionally. It's good you're not worrying about dying, so many of us do when first dx. Best of luck to you with your app'ts.
love
jan0 -
Glad you enjoyed the articledivablu said:Thank you!!!
What a great article! I'm going to send this to my radiation doc and oncologist.
And I'll probably have to read it two or three more times to get all the info ... chemo brain you know! =]
Glad you enjoyed the article and good to see you posting again. Hope you're feeling well.
love
jan0
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