Anxiety

Patients may not address “end-of-life issues” because of stress and anxiety. In my experience, I have found that patients are often under more stress and anxiety when discussions about prognosis and goals of care have not occurred. People approach a cancer diagnosis and treatment differently, influenced by their personalities, life experiences, education as well as personal and spiritual beliefs. It is important to first understand how a patient is coping with and understanding their illness and prognosis. Stress and anxiety often arise from misunderstanding and/or fear about the underlying illness. If this is the case, starting a dialogue with the patient, to clarify misconceptions and openly address patient and family fears, will help to dissipate stress and anxiety and allow an open discourse about prognosis and patient wishes for care at the end of life. Patients may not address “end-of-life issues” because of stress and anxiety. In my experience, I have found that patients are often under more stress and anxiety when discussions about prognosis and goals of care have not occurred. People approach a cancer diagnosis and treatment differently, influenced by their personalities, life experiences, education as well as personal and spiritual beliefs. It is important to first understand how a patient is coping with and understanding their illness and prognosis. Stress and anxiety often arise from misunderstanding and/or fear about the underlying illness. If this is the case, starting a dialogue with the patient, to clarify misconceptions and openly address patient and family fears, will help to dissipate stress and anxiety and allow an open discourse about prognosis and patient wishes for care at the end of life.

Uncertainty, especially under the circumstances of a cancer diagnosis, is one of most stressful experiences. I recommend exercise, meditation, and relaxation exercises as ways to cope with stress during this time. Check out this book by Dr. Michael Antoni, one of the leading researchers in this area: http://www.amazon.com/Stress-Management-Intervention-Breast-Cancer/dp/1557989419/ref=sr_1_2?s=books&ie=UTF8&qid=1332591278&sr=1-2 I also highly recommend finding online social networks, like on http://www.PatientsLikeMe.com to find and connect with others going through what you are going through. Even though family and friends may be supportive, it can be so helpful to talk to people who have been through or are going through what you are going through. Only they can truly understand your fears and concerns. And, because the people you meet in online social networks are not close family and friends, you may actually be able to speak more freely about your thoughts, feelings and challenges, especially to the extent that some of the challenges involve family and friends reactions to your cancer. Uncertainty, especially under the circumstances of a cancer diagnosis, is one of most stressful experiences. I recommend exercise, meditation, and relaxation exercises as ways to cope with stress during this time. Check out this book by Dr. Michael Antoni, one of the leading researchers in this area: http://www.amazon.com/Stress-Management-Intervention-Breast-Cancer/dp/1557989419/ref=sr_1_2?s=books&ie=UTF8&qid=1332591278&sr=1-2 I also highly recommend finding online social networks, like on http://www.PatientsLikeMe.com to find and connect with others going through what you are going through. Even though family and friends may be supportive, it can be so helpful to talk to people who have been through or are going through what you are going through. Only they can truly understand your fears and concerns. And, because the people you meet in online social networks are not close family and friends, you may actually be able to speak more freely about your thoughts, feelings and challenges, especially to the extent that some of the challenges involve family and friends reactions to your cancer.

It can be difficult to make someone confront their stress and anxiety. I recommend that you share your concern with them, but be sure not to push too hard. You might say, “I’m worried about you. You seem very stressed out, is there anything I can do to help?” If they aren’t open to admitting it or discussing it, you might try to help reduce their stressors. Make sure to give them time to relax, try not to place too many demands on them, and make them feel comfortable confiding in you. You might also invite them to do stress reducing activities with you—like going for walks. If they sense that you are pushing it though, they will feel less inclined to speak to you about it. If there is a friend or family member that this person may feel more comfortable talking to you might try to connect them with that person. Keep in mind that when we don’t acknowledge something about ourselves it is because we are not ready. You can’t make someone ready to acknowledge a problem or to deal with it. In the meantime, if the situation is causing you stress, you might focus on managing your own stress about it. It can be difficult to make someone confront their stress and anxiety. I recommend that you share your concern with them, but be sure not to push too hard. You might say, “I’m worried about you. You seem very stressed out, is there anything I can do to help?” If they aren’t open to admitting it or discussing it, you might try to help reduce their stressors. Make sure to give them time to relax, try not to place too many demands on them, and make them feel comfortable confiding in you. You might also invite them to do stress reducing activities with you—like going for walks. If they sense that you are pushing it though, they will feel less inclined to speak to you about it. If there is a friend or family member that this person may feel more comfortable talking to you might try to connect them with that person. Keep in mind that when we don’t acknowledge something about ourselves it is because we are not ready. You can’t make someone ready to acknowledge a problem or to deal with it. In the meantime, if the situation is causing you stress, you might focus on managing your own stress about it.

I would recommend learning: to effectively relax, better comfort management, imagery and visualization for rapid and effective healing, improved confidence, and knowing what behavioral and mind-body steps they can implement for greater healing and recovery. I published a paper on the subject of hypnosis and surgery which is available for download at this link - http://www.healingwithhypnosis.com/AZCIM/Gurgevich_SurgeryHypnosis.pdf. I also have an audio program available from my website called “Surgery and Recovery” - http://www.healingwithhypnosis.com/mm5/merchant.mvc?Screen=PROD&Product_code=000033. I would recommend learning: to effectively relax, better comfort management, imagery and visualization for rapid and effective healing, improved confidence, and knowing what behavioral and mind-body steps they can implement for greater healing and recovery. I published a paper on the subject of hypnosis and surgery which is available for download at this link - http://www.healingwithhypnosis.com/AZCIM/Gurgevich_SurgeryHypnosis.pdf. I also have an audio program available from my website called “Surgery and Recovery” - http://www.healingwithhypnosis.com/mm5/merchant.mvc?Screen=PROD&Product_code=000033.

This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist. This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist.

You choice to have bilateral mastectomy has certainly reduced the likelihood of a new cancer in the same breast and vastly reduced the chance of a cancer in the opposite breast. Adjuvant chemotherapy (and hormonal therapy when indicated) has reduced your chance of recurrence. Oophorectomy has diminished your chance of ovarian cancer.

It would be glib to say "don't worry". I just read an article by a survivor of endometrial cancer who thinks about her cancer 24/7. Thinking about cancer will be inevitable for someone who has undergone treatment. I advise my patients to reverse their thought process, think about the cancer not coming back, rather than it coming back.

I strongly recommend regular exercise, which has been shown to reduce recurrence rates.

When a patient misses a followup appointment with me, it means they are not dwelling on their cancer, and are off doing other things, and that's good. You choice to have bilateral mastectomy has certainly reduced the likelihood of a new cancer in the same breast and vastly reduced the chance of a cancer in the opposite breast. Adjuvant chemotherapy (and hormonal therapy when indicated) has reduced your chance of recurrence. Oophorectomy has diminished your chance of ovarian cancer.

It would be glib to say "don't worry". I just read an article by a survivor of endometrial cancer who thinks about her cancer 24/7. Thinking about cancer will be inevitable for someone who has undergone treatment. I advise my patients to reverse their thought process, think about the cancer not coming back, rather than it coming back.

I strongly recommend regular exercise, which has been shown to reduce recurrence rates.

When a patient misses a followup appointment with me, it means they are not dwelling on their cancer, and are off doing other things, and that's good.

One of the most common psychological responses to the experience of cancer is anxiety!

A clear distinction does not always exist between the normal fears that cancer initiates and other anxiety reactions that are intense. What is known is that cancer is a stressful journey and normal anxiety reactions present at different points along the cancer continuum: at diagnosis, during treatment, at recurrence, and other times when the patient does not know what to expect and feels powerless to what is happening to them.

The most effective anxiety and stress relief technique I have found is in the form of education! I believe that if the patient has insight and knowledge about what exactly is happening to them and what they are facing, it gives them a sense of control and empowerment. Thus, decreasing the amount of stress and anxiety! For example, if I were to do a bone marrow biopsy on a patient I would first explain the purpose of the test. I would then take the person through the procedure one step at a time so that they would know what to expect at each moment in time.

Apprehension and fear drive stress and anxiety. Feelings of helplessness also contribute to stress and anxiety. To me, knowledge translates into control. It is important for us as healthcare practitioners to make the patient an informed "partner" in the his or her health care plan.

After education I believe in relaxation techniques such as progressive relaxation, deep breathing, guided imagery, yoga, biofeedback, and meditation. Progressive relaxation and deep breathing techniques can be learned easily by the patient and can give them a sense of control over what may be a frightening treatment or procedure. Listening to relaxation or guided imagery tapes during chemotherapy treatments is very effective in reducing anxiety.

There is also a role for the short term use of anxiolytics (drugs that reduce anxiety) such as the benzodiazepenes (ativan, xanax, etc) but these should be reserved for special circumstances, e.g., the fear and physical discomfort associated with a bone marrow biopsy.

Educating the patient is weaved through all the interventions mentioned and is my number one choice! One of the most common psychological responses to the experience of cancer is anxiety!

A clear distinction does not always exist between the normal fears that cancer initiates and other anxiety reactions that are intense. What is known is that cancer is a stressful journey and normal anxiety reactions present at different points along the cancer continuum: at diagnosis, during treatment, at recurrence, and other times when the patient does not know what to expect and feels powerless to what is happening to them.

The most effective anxiety and stress relief technique I have found is in the form of education! I believe that if the patient has insight and knowledge about what exactly is happening to them and what they are facing, it gives them a sense of control and empowerment. Thus, decreasing the amount of stress and anxiety! For example, if I were to do a bone marrow biopsy on a patient I would first explain the purpose of the test. I would then take the person through the procedure one step at a time so that they would know what to expect at each moment in time.

Apprehension and fear drive stress and anxiety. Feelings of helplessness also contribute to stress and anxiety. To me, knowledge translates into control. It is important for us as healthcare practitioners to make the patient an informed "partner" in the his or her health care plan.

After education I believe in relaxation techniques such as progressive relaxation, deep breathing, guided imagery, yoga, biofeedback, and meditation. Progressive relaxation and deep breathing techniques can be learned easily by the patient and can give them a sense of control over what may be a frightening treatment or procedure. Listening to relaxation or guided imagery tapes during chemotherapy treatments is very effective in reducing anxiety.

There is also a role for the short term use of anxiolytics (drugs that reduce anxiety) such as the benzodiazepenes (ativan, xanax, etc) but these should be reserved for special circumstances, e.g., the fear and physical discomfort associated with a bone marrow biopsy.

Educating the patient is weaved through all the interventions mentioned and is my number one choice!

I suggest you concentrate on the idea of surviving and living rather than the prospects of dying. Do positive things that make you happy, be with positive people and start enjoying life. Try meditation, healing drumming, anything to get your mind off of the negative vs. the positive. Visualize the cancer leaving your body for good and that your body will kill of the cancer cells if they return. Believe it! Believe in yourself and the ability to heal. Also take dietary steps to keep your immune system up and running-avoid sugars if possible, eat more greens, cut out dairy and eat meat only in moderation. Exercise the mind and the body and you will be on the road to healing and living out the rest of your days at peace. I suggest you concentrate on the idea of surviving and living rather than the prospects of dying. Do positive things that make you happy, be with positive people and start enjoying life. Try meditation, healing drumming, anything to get your mind off of the negative vs. the positive. Visualize the cancer leaving your body for good and that your body will kill of the cancer cells if they return. Believe it! Believe in yourself and the ability to heal. Also take dietary steps to keep your immune system up and running-avoid sugars if possible, eat more greens, cut out dairy and eat meat only in moderation. Exercise the mind and the body and you will be on the road to healing and living out the rest of your days at peace.

Anxiety is the result of putting ourselves into the future and anticipating bad things. Mindfulness is a philosophe re-discovered by Jon Kabat-Zinn that suggests that if we can live in this moment, this one... where we are living and breathing, we can moderate our anxiety and depression considerably. Mindfulness is a simple concept but a challenge to perfect. Here is a program by Dr. Kabat-Zinn where he describes the approach. http://www.youtube.com/watch?v=qvXFxi2ZXT0 Look for his book "Full Catastrophe Living" or "Mindfulness for Beginners."

Using yoga breathing at the time of sleep as well as stretching can reduce muscle tension and the levels of excitatory hormones in your body that could be involved.

Since I'm not a doctor or herbologist, I can't comment on medications or herbal remedies. Check with your doctor before beginning any herbal or natural remedies as they can interact with medications you take and cause serious consequences. I also suffer an anxiety disorder and have had to address this myself. When I started to meditate I felt a world of difference with the stress and actually felt a power within myself. On my first breast cancer surgery I was meditating before I went under and woke up so calm. Whenever I have to have my mammogram waiting for the radiologist to tell me the results I also meditate and take deep breaths to calm myself down. It really does work. Even taking deep breaths calms the mind.

Hard to compare. Alopecia wasn't the result of a decision I made or remotely within my control. Electing to have prophylactic risk reducing surgeries like mastectomy and oopherectomy was an entirely patient-driven decision. Being elective, and especially having happened back when risk-reducing surgery in the context of BRCA carrier status was new ground, I was on my own. My doctors were not able or willing to weigh in on my decision so that put a tremendous amount of patient responsibility on my shoulders. Once I made the decision though, I did not agonize at all. It was a relief because living with the constant fear of a breast cancer diagnosis is far more agonizing. Hard to compare. Alopecia wasn't the result of a decision I made or remotely within my control. Electing to have prophylactic risk reducing surgeries like mastectomy and oopherectomy was an entirely patient-driven decision. Being elective, and especially having happened back when risk-reducing surgery in the context of BRCA carrier status was new ground, I was on my own. My doctors were not able or willing to weigh in on my decision so that put a tremendous amount of patient responsibility on my shoulders. Once I made the decision though, I did not agonize at all. It was a relief because living with the constant fear of a breast cancer diagnosis is far more agonizing.

A sense of humor helps a lot. I learned very early on to always bring someone with me to doctors appointments. I was incapable of remember anything that was said and having someone there and knowing I didn’t have to remember, was a huge relief for me.

Around our home, my forgetfulness got to be a joke, especially with my daughter. In fact, I am sure she used it to her advantage many times, but to be able to laugh about not remembering that I told her she could go somewhere was actually good. You just have to accept that, as I say in my book, “Your brain literally takes the next bus to Toledo.” My family learned pretty quickly to write everything down for me and it saved us all a lot of grief later.

The anxiety is a different story. I never could get comfortable in my own skin. I felt alien to myself and like I didn’t belong anywhere. It got so bad that I felt like I was about to have panic attacks and for a Type A personality like me, who used to think that things like that were absurd, it was difficult to accept. But I did find a way and it is something I still use today. There is a chapter in my book dedicated to it. It is called “Stop Thinking and Start Thanking.”

Basically, every time I would start to get that gnawing, overwhelming panic, I would make myself stop thinking about whatever had triggered the panic, and start a “Thanking” session. I would literally count my blessings. I would look around the room and begin telling myself how blessed I was to live in the home I had and how beautiful the vase of flowers on the kitchen island was. I would find everything I could to be thankful for and within a few minutes, my blood pressure would lower, my breathing would stabilize and then calmness would return. It may sound hokey, but believe me, it worked every time. It is a technique I will continue to use for the rest of my life.

Depression is one of the hardest parts of this disease emotionally. If your diagnosis and treatment have been extensive, depression is much more likely to happen and to sometimes be severe. I know for myself, the road back to feeling normal was a very long one. It took me almost two years after my final treatment to feel comfortable in my own skin again. I have to say that I think people who go through cancer are some of the bravest, strongest people on the planet and in saying this, I want you to understand that you have nothing to prove to anyone so if you need help, in the way of counseling or anti-depressants, please make sure you give yourself permission to do what you need to do.

The light at the end of the tunnel may seem far away, but you will get there. Take each day one moment at a time. Love until it hurts, laugh until you are exhausted, take advantage of all the help that surrounds you and never, ever apologize for having done so.

I am fortunate to be able to swim pretty much every day and that is true escape time. The pool is outdoor and I clock up 800 metres before work which sets me up emotionally and mentally as much as physically.

I also rely on music with playlists according to mood! I also enjoy reading as an escape. And watching butterflies in the garden - I can do that for ages!!
:) Many times during the day I can get stressed out; teenagers, work and health issues are usually the cause. And many times there is just no time to grab an hour here or there to meditate uninterrupted! So I compiled a CD of some really "feel good" insirational songs I especially love to sing along with and play it in the car whenever I am feeling stressed or down. Works for me! :)

Debbie - Thank you for your question. Today, I have been plagued with an intense feeling of anxiety, so I must be honest when I admit that the anxiety that comes with change never really goes away. But, I have learned to accept that anxiety is part of the process. I am also learning to accept that the anxiety never stays forever and eventually it gets replaced with the joy of a new experience.

I wrote a post about this back in December and included in it is a great quote by a Hopi elder about Letting Go Of The Shore. When I am having a particularly challenging day, I like to re-read the quote and remind myself that "the river has a destination".

So...that's what I'm doing today. Breathing into a paper bag and reminding myself to Let Go Of The Shore and just enjoy the journey...

Here's the link to the post: http://www.afreshchapter.com/letting-go-of-the-shore.html

But, in case you just want to read the quote, here it is:

“There is a river flowing now very fast. It is so great and swift that there are those that will be afraid. They will try to hold on to the shore. They will feel that they are torn apart and will suffer greatly.

Know that the river has its destination. The elders say that we must let go of the shore, push off into the middle of the river, keep our eyes open, and our heads above water. And I say, see who is in there with you and celebrate. At this time in history, we are to take nothing personally, least of all ourselves. For the moment that we do, our spiritual growth and journey come to a halt.

The time for the lone wolf is over. Gather yourselves! Banish the word struggle from your attitude and your vocabulary. All that we do now must be done in a sacred manner and in celebration.

For we are the ones that we have been waiting for.”
Debbie - Thank you for your question. Today, I have been plagued with an intense feeling of anxiety, so I must be honest when I admit that the anxiety that comes with change never really goes away. But, I have learned to accept that anxiety is part of the process. I am also learning to accept that the anxiety never stays forever and eventually it gets replaced with the joy of a new experience.

I wrote a post about this back in December and included in it is a great quote by a Hopi elder about Letting Go Of The Shore. When I am having a particularly challenging day, I like to re-read the quote and remind myself that "the river has a destination".

So...that's what I'm doing today. Breathing into a paper bag and reminding myself to Let Go Of The Shore and just enjoy the journey...

Here's the link to the post: http://www.afreshchapter.com/letting-go-of-the-shore.html

But, in case you just want to read the quote, here it is:

“There is a river flowing now very fast. It is so great and swift that there are those that will be afraid. They will try to hold on to the shore. They will feel that they are torn apart and will suffer greatly.

Know that the river has its destination. The elders say that we must let go of the shore, push off into the middle of the river, keep our eyes open, and our heads above water. And I say, see who is in there with you and celebrate. At this time in history, we are to take nothing personally, least of all ourselves. For the moment that we do, our spiritual growth and journey come to a halt.

The time for the lone wolf is over. Gather yourselves! Banish the word struggle from your attitude and your vocabulary. All that we do now must be done in a sacred manner and in celebration.

For we are the ones that we have been waiting for.”

do guided imagery and meditate
so you visualize what you desire and not what you fear. do guided imagery and meditate
so you visualize what you desire and not what you fear.

I have experienced this loneliness first hand and so have my clients. Cancer poses issues fundamental to our being, such as "who am I", "what is my purpose", "what is my legacy", what is really important?", "what do I want to do with the rest of my life?. These difficult questions need to be answered to move forward with the "new" life.

When the loved ones return to their "old" lives we may feel stuck and lonely sorting out what our "new" life will be.

Do what you feel your body, mind and spirit are calling for. Your loneliness will dissolve, replaced by the feelings of peace, comfort and love. What great insights. Many of my clients have expressed similar experiences and challenges. Change and the unknown are both known for producing anxiety, worry and fear. Elyn's recommendation of connecting with others who share similar experiences is excellent. It helps people to know they aren't alone and also there is often an opportunity to share helpful ideas and resources to address the issues. Reaching out to other survivors here on the site is a possibility. There are also mentor matching programs through American Cancer Society, Immerman's Angels and other online communities that can help alleviate the isolation. One comment shared by most of my group coaching clients is that being coached in a group experience helped them all feel less alone and see their issues were more common than they ever imagined. It helped them to be less self-critical and create more self-acceptance.

Overall make sure you are aware of both your body and mind. Your body will have clues as to your stress level through things like heart rate, respirations, persperation, trembling, muscle tension, fidgeting, nausea, diarrhea, etc. Your mind will give you clues like difficulty concentrating or focusing, racing thoughts, obsessive thoughts, catastrophic thoughts, fear provoking thoughts, etc.

Managing stress in the workplace is the same as managing stress anywhere. Start by de-activating the Fight/Flight response by changing your breathing pattern. Make your breathing longer, slower, deeper and more regular. Get to a quieter area and stretch muscles; try to force yourself to yawn. If you have a workplace that includes a gym or workout area, burn off some of that energy (exercise actually makes the brain think and learn better anyway).

Once you have started to get your bodily reaction calmed down, focus on changing the content of your thinking. If you are fixated on deadlines and failing and getting fired, you're just scaring yourself to death. Think about what you need to accomplish and begin by prioritizing. Break big tasks into little steps and start accomplishing them. When your mind jumps back to "You have to get this done NOW!" tell yourself that's just what you are doing; getting it done, one step at a time.

If your stress involves relationships with co-workers, supervisors or clients/customers, then take a look at what is common about the people who are frustrating or stressing you out. Try to identify the trigger and see if you can innoculate yourself against it. Try to see what their purpose is in behaving the way they do and anticipate their actions in the future. Tell yourself it doesn't really matter that it happens.

Think about your work not as who you are but something you do. Disconnect your identity from your job title. Your worth as a person is not related to how much you get done or if you met a particular deadline.

Look for the things in your life for which you are grateful and keep them in your mind. Especially when those thngs are benefitted by the work that you do or the check you bring home at the end of the week.

I keep an image of the universe in my computer to pull up and stare at now and then. I put a little tiny red arrow on it with the words, "You are here." It helps me remeber how inconsequential most things that happen in life really are. After a few minutes, some deep breaths and a renewed determination, I go back to it... and git'r dun! Overall make sure you are aware of both your body and mind. Your body will have clues as to your stress level through things like heart rate, respirations, persperation, trembling, muscle tension, fidgeting, nausea, diarrhea, etc. Your mind will give you clues like difficulty concentrating or focusing, racing thoughts, obsessive thoughts, catastrophic thoughts, fear provoking thoughts, etc.

Managing stress in the workplace is the same as managing stress anywhere. Start by de-activating the Fight/Flight response by changing your breathing pattern. Make your breathing longer, slower, deeper and more regular. Get to a quieter area and stretch muscles; try to force yourself to yawn. If you have a workplace that includes a gym or workout area, burn off some of that energy (exercise actually makes the brain think and learn better anyway).

Once you have started to get your bodily reaction calmed down, focus on changing the content of your thinking. If you are fixated on deadlines and failing and getting fired, you're just scaring yourself to death. Think about what you need to accomplish and begin by prioritizing. Break big tasks into little steps and start accomplishing them. When your mind jumps back to "You have to get this done NOW!" tell yourself that's just what you are doing; getting it done, one step at a time.

If your stress involves relationships with co-workers, supervisors or clients/customers, then take a look at what is common about the people who are frustrating or stressing you out. Try to identify the trigger and see if you can innoculate yourself against it. Try to see what their purpose is in behaving the way they do and anticipate their actions in the future. Tell yourself it doesn't really matter that it happens.

Think about your work not as who you are but something you do. Disconnect your identity from your job title. Your worth as a person is not related to how much you get done or if you met a particular deadline.

Look for the things in your life for which you are grateful and keep them in your mind. Especially when those thngs are benefitted by the work that you do or the check you bring home at the end of the week.

I keep an image of the universe in my computer to pull up and stare at now and then. I put a little tiny red arrow on it with the words, "You are here." It helps me remeber how inconsequential most things that happen in life really are. After a few minutes, some deep breaths and a renewed determination, I go back to it... and git'r dun!

The most effective thing I have learned and taught is to focus your mind on your breathing while making an attempt to change your breathing pattern. Panic comes from the triggering of the body's Fight or Flight response, a natural, protective action your body takes automatically when there is a perceived threat. With high stress levels, a lack of self-care and/or pain or chronic health conditions, the Fight or Flight response can be triggered by events and things that are not immenent threats. My favorite breathing technique is listed on "Breathing the Master Key to Self Healing" a CD by Dr. Andrew Weil. The specific technique is called the Relaxing Breath and it goes like this: 1) hold the tip of your tongue to the roof of your mouth just behind your front teeth about 1/4 inch (keep it there throughout this process), 2) breathe in through your nose for the count of four, 3) hold it in your belly for the count of seven and 4) blow out through pursed lips for the count of eight until your lungs can't push out any more air. Repeat these steps four to eight times depending on your lung capacity. Use your diaphram (stomach) muscle to sustain your breath and don't let it all spill out at once. Breathing out slowly will slow your heart rate down and controlling your breath will increase the amount of oxygen in your blood stream. You may feel dizzy or light headed at first. That may be an indicator to speed up or slow down your counting. How fast isn't important. What is important is the ratio of 4-7-8. If your breathing is impaired, just try focusing on making your breathing slower, longer, deeper and more regular. Put the picture in your mind's eye of a slow wave crawling up the beach and retreating. Try to match your breathing pattern to that wave's motion. Doing these techniques can help you to reverse the Fight or Flight response and allow you to think a little clearer and more rationally. Practice it at least a couple times a day and notice how you feel afterwards. Use it before something that causes you anxiety. Keep a small mood log or chart to track your progress. Rate your anxiety or panic on the pain scale of 0 to 10. You might not feel a great difference at first, but with practice you can decrease the intensity of your panic, shorten it's duration and even prevent an attack altogether. Once you come to see you have something under your control that helps with your distress, the pressure you feel to prevent another attack will subside. It helped me deal with my own anxiety for about 15 years now. And it's drug free! The most effective thing I have learned and taught is to focus your mind on your breathing while making an attempt to change your breathing pattern. Panic comes from the triggering of the body's Fight or Flight response, a natural, protective action your body takes automatically when there is a perceived threat. With high stress levels, a lack of self-care and/or pain or chronic health conditions, the Fight or Flight response can be triggered by events and things that are not immenent threats. My favorite breathing technique is listed on "Breathing the Master Key to Self Healing" a CD by Dr. Andrew Weil. The specific technique is called the Relaxing Breath and it goes like this: 1) hold the tip of your tongue to the roof of your mouth just behind your front teeth about 1/4 inch (keep it there throughout this process), 2) breathe in through your nose for the count of four, 3) hold it in your belly for the count of seven and 4) blow out through pursed lips for the count of eight until your lungs can't push out any more air. Repeat these steps four to eight times depending on your lung capacity. Use your diaphram (stomach) muscle to sustain your breath and don't let it all spill out at once. Breathing out slowly will slow your heart rate down and controlling your breath will increase the amount of oxygen in your blood stream. You may feel dizzy or light headed at first. That may be an indicator to speed up or slow down your counting. How fast isn't important. What is important is the ratio of 4-7-8. If your breathing is impaired, just try focusing on making your breathing slower, longer, deeper and more regular. Put the picture in your mind's eye of a slow wave crawling up the beach and retreating. Try to match your breathing pattern to that wave's motion. Doing these techniques can help you to reverse the Fight or Flight response and allow you to think a little clearer and more rationally. Practice it at least a couple times a day and notice how you feel afterwards. Use it before something that causes you anxiety. Keep a small mood log or chart to track your progress. Rate your anxiety or panic on the pain scale of 0 to 10. You might not feel a great difference at first, but with practice you can decrease the intensity of your panic, shorten it's duration and even prevent an attack altogether. Once you come to see you have something under your control that helps with your distress, the pressure you feel to prevent another attack will subside. It helped me deal with my own anxiety for about 15 years now. And it's drug free!

sometimes its because I've started shaking violently, other times its because my thoughts start racing in an unusual way & sometimes its because my heart actually starts racing hard. but keep in mind i have a C-PTSD diagnosis with Anxiety disorder & Panic disorder as well. If my anxiety gets too severe i have more physical symptoms & can develop diarrhea & vomiting & dizzyness etc. The worse the Anxiety/Panic, the worse the symptoms (for me anyways). I know when I am anxious when I have difficulty making simple decisions, such as what to have for breakfast. I start to think too quickly and cannot settle on one idea. I get these feeling of apprehension and dread about making a simple decision. I get really tired and have difficulty sleeping. The whole idea of concentrating on one item to make and being able to make that decision is impossible. My hear beats faster, it is harder to catch my breathe and I feel dizzy.

I find that the best thing for me to do is to acknowledge that I am anxious. Once I recognize my own signs of anxiety, I am am to slow down my thoughts and focus on breathing and talk myself through it.

Some other signs of anxiety are: feeling tense/jumpy, irritability, restlessness, sweating, upset stomach, diarrhea, excessive urination, twitches, muscle tension and headaches.

I also notice that I can attach my anxiety to one activity. For example when my mom told me she had breast cancer again, I started to get anxious during one of my favorite activities, food shopping. I would enter the grocery store and become very anxious. I was overwhelmed by all of the people around me and did not want anyone to touch me. There were too many choices of what to buy.

To overcome this problem, I started to bring someone along with me. They were able to help distract me from getting caught up in a whirlwind of thoughts.

The other solution that helps me is of course talking about things with someone I trust.

Hearing that someone you love has breast cancer affects everyone differently. Since the possibility of death is there, I find that everyone seems to go through the stages of grief - denial, anger, bargaining, depression and acceptance.

It is easy to get stuck in any one of these stages, possibly even for years. Anger or depression are two stages that are easy to hold on to even after treatment is over. I was depressed for a long time after my mothers first diagnosis.

For me seeing a therapist was a life saver. The anxiety, anger and depression I was feeling was affecting my work, my social life, my relationships, etc. I was terrified of talking about cancer in my therapy sessions and instead kept busy talking about the other issues I was having. I was still partly in the denial stage and saying the words aloud were difficult. But now after therapy I feel as though I have finally accepted the reality of the situation.

At first I thought therapy was a never ending experience that I would have to go every week for years. But I just went for a few months until I felt my anxiety was easy to handle and I was able to say my mom has cancer aloud without breaking down.

If you have insurance, out-patient therapy may be covered. If you are without coverage, look for therapists and social workers in your area as they may work on a sliding scale fee, meaning your fee is based on your income. Group therapy may also be a free or inexpensive option.

You can ask and answer questions on this site at any time of day or night and someone will answer. You never know, you may be asking a question someone else is too afraid to ask. Beyondboobsinc.org has listing of support groups as well as ways to start your own. Menagainstbreastcancer.org supports husbands, sons and dads of breast cancer patients.

Taking care of you mental health is important and necessary when you are taking care of someone else. One other way that I made myself feel better was to start checking myself regularly for preventive needs. You can check out selfchec.org for how-tos, and to sign up for monthly reminders for you and your loved ones. Hearing that someone you love has breast cancer affects everyone differently. Since the possibility of death is there, I find that everyone seems to go through the stages of grief - denial, anger, bargaining, depression and acceptance.

It is easy to get stuck in any one of these stages, possibly even for years. Anger or depression are two stages that are easy to hold on to even after treatment is over. I was depressed for a long time after my mothers first diagnosis.

For me seeing a therapist was a life saver. The anxiety, anger and depression I was feeling was affecting my work, my social life, my relationships, etc. I was terrified of talking about cancer in my therapy sessions and instead kept busy talking about the other issues I was having. I was still partly in the denial stage and saying the words aloud were difficult. But now after therapy I feel as though I have finally accepted the reality of the situation.

At first I thought therapy was a never ending experience that I would have to go every week for years. But I just went for a few months until I felt my anxiety was easy to handle and I was able to say my mom has cancer aloud without breaking down.

If you have insurance, out-patient therapy may be covered. If you are without coverage, look for therapists and social workers in your area as they may work on a sliding scale fee, meaning your fee is based on your income. Group therapy may also be a free or inexpensive option.

You can ask and answer questions on this site at any time of day or night and someone will answer. You never know, you may be asking a question someone else is too afraid to ask. Beyondboobsinc.org has listing of support groups as well as ways to start your own. Menagainstbreastcancer.org supports husbands, sons and dads of breast cancer patients.

Taking care of you mental health is important and necessary when you are taking care of someone else. One other way that I made myself feel better was to start checking myself regularly for preventive needs. You can check out selfchec.org for how-tos, and to sign up for monthly reminders for you and your loved ones.