Tips

My period returned about 10 months after chemo had ended. The farther away from true menopause you were before chemo began, (i.e. the younger you were), the highly likelihood it would return, is what my oncologist told me. I was 45 years old when diagnosed. My mother didn't finish menopause until she was 65. If I follow in her footsteps, true menopause for me is still a ways off. As for relief during chemo, I used Black Cohosh but didn't feel like it helped me personally. Keep in mind you may begin Tamoxifen as soon as chemo ends and the symptoms may continue and have nothing at all to do with chemo and everyting to do with Tamoxifen. I found I had more vaginal dryness, shrinkage on Tamoxifen, and obviously after chemo ended this became a real problem. Other intollerable side effects on Tamoxifen caused me to discontinue it after 5 1/2 months use. Exercise, Dr. Schwartz is correct, is key to battling some of the menopausal side effects of treatment. It helped more than anything I put in my mouth. Women should use personal fans (motor-operated) to keep down the hot sweats and night sweats. They should not take any estrogen-based drug to counter these symptoms if their cancer is ER positive. Take cooler showers and eat a balanced diet with lots of vegetables, fruits, and whole grains. Keep the skin moist with some good moisturizing cream like Eucerin to avoid cracking skin. All these things do help.

If you're newly diagnosed and have not yet begun treatment, ask your oncologist for a referral to a neuropsychologist for a cognitive evaluation. That will provide you with a baseline of how your brain functions now in terms of memory, attention, mood, etc. Follow-up testing during and after treatment will help your doctors monitor your cognitive health over time.

Even if you've already begun treatment, this type of testing can help. Neuropsychologists - especially those who work with cancer patients -- can suggest individualized coping strategies. They may also suggest medication if they think you'll benefit.

And just as having cancer affects the entire family, so does chemo brain. I can't tell you how many stories I've collected from people who tell me that their spouses and/or children just don't understand why they continue to be so forgetful, even though they're long past treatment. So you might sit down with your family and explain that chemo brain is real and that it may continue to linger. You may want to ask them to work out organizational strategies with you so that everyone takes a bit more responsibility.

It may help for them to read "Your Brain After Chemo" where I tell the story of a husband who had testicular cancer, and his wife who was often frustrated at how spacey he had become. In the end, they set up a more structured way of dealing with appointments, including their roles in picking up their son after school. That created more harmony at home. If you're newly diagnosed and have not yet begun treatment, ask your oncologist for a referral to a neuropsychologist for a cognitive evaluation. That will provide you with a baseline of how your brain functions now in terms of memory, attention, mood, etc. Follow-up testing during and after treatment will help your doctors monitor your cognitive health over time.

Even if you've already begun treatment, this type of testing can help. Neuropsychologists - especially those who work with cancer patients -- can suggest individualized coping strategies. They may also suggest medication if they think you'll benefit.

And just as having cancer affects the entire family, so does chemo brain. I can't tell you how many stories I've collected from people who tell me that their spouses and/or children just don't understand why they continue to be so forgetful, even though they're long past treatment. So you might sit down with your family and explain that chemo brain is real and that it may continue to linger. You may want to ask them to work out organizational strategies with you so that everyone takes a bit more responsibility.

It may help for them to read "Your Brain After Chemo" where I tell the story of a husband who had testicular cancer, and his wife who was often frustrated at how spacey he had become. In the end, they set up a more structured way of dealing with appointments, including their roles in picking up their son after school. That created more harmony at home.

There are a few that top the list.

Physical exercise - There's plenty of research showing that physical exercise increases cerebral blood flow and promotes the growth of brain cells. Even getting out and vigorously walking two or three times a week can help.

Brain foods - Most people don't generally think about "fats" when it comes to our diet post-chemo. But there are good fats that promote brain health and bad fats that do just the opposite. Avoid saturated fats (i.e.: cheese, whole milk, fatty animal products, palm oil), and trans fats (found in some commercial baked goods, snacks such as potato chips, fried foods, etc.). Both types of fat can cause clogging of the arteries and poor blood flow to the brain.

The good-guy fats are omega-3 fatty acids found in seafood and some plant sources (there's a chart of omega-3 foods in our book). Omega-3 fats have been shown to fight inflammation and help with depression. And in studies of omega-3 supplements, subjects showed improved attention in tasks involving complex reasoning.

Get more fruits and vegetables into your diet. In a study out just last week (journal Neurology - online version, 12-28-11), researchers found that participants with high blood levels of vitamins B,C, D and E, scored better in the areas of attention, visuospatial skills and executive functioning (decision making, reasoning, planning ahead) than a control group. They also found that those with high levels of trans fat demonstrated worse overall functioning in the areas of attention, memory, language and processing speed.

Mind games - Some neuropsychologists believe that playing games such as sudoku, or working crossword puzzles, will help you improve at those specific games but may not help with overall cognitive impairment. That's why it's important to engage in a wide variety of cognitive activities, such as reading more (even if it takes you longer because of problems with concentration), or trying something completely novel, such as taking up piano if you've never played before.

Organizational strategies - Find a way to structure your life that works for you, whether that means relying on digital or day planners, bundling tasks (such as always taking your pills when you brush your teeth) so that one helps you remember the other), or laying out your clothes for the morning before you go to bed. Doing what you can to organize your life will reduce stress. There are a few that top the list.

Physical exercise - There's plenty of research showing that physical exercise increases cerebral blood flow and promotes the growth of brain cells. Even getting out and vigorously walking two or three times a week can help.

Brain foods - Most people don't generally think about "fats" when it comes to our diet post-chemo. But there are good fats that promote brain health and bad fats that do just the opposite. Avoid saturated fats (i.e.: cheese, whole milk, fatty animal products, palm oil), and trans fats (found in some commercial baked goods, snacks such as potato chips, fried foods, etc.). Both types of fat can cause clogging of the arteries and poor blood flow to the brain.

The good-guy fats are omega-3 fatty acids found in seafood and some plant sources (there's a chart of omega-3 foods in our book). Omega-3 fats have been shown to fight inflammation and help with depression. And in studies of omega-3 supplements, subjects showed improved attention in tasks involving complex reasoning.

Get more fruits and vegetables into your diet. In a study out just last week (journal Neurology - online version, 12-28-11), researchers found that participants with high blood levels of vitamins B,C, D and E, scored better in the areas of attention, visuospatial skills and executive functioning (decision making, reasoning, planning ahead) than a control group. They also found that those with high levels of trans fat demonstrated worse overall functioning in the areas of attention, memory, language and processing speed.

Mind games - Some neuropsychologists believe that playing games such as sudoku, or working crossword puzzles, will help you improve at those specific games but may not help with overall cognitive impairment. That's why it's important to engage in a wide variety of cognitive activities, such as reading more (even if it takes you longer because of problems with concentration), or trying something completely novel, such as taking up piano if you've never played before.

Organizational strategies - Find a way to structure your life that works for you, whether that means relying on digital or day planners, bundling tasks (such as always taking your pills when you brush your teeth) so that one helps you remember the other), or laying out your clothes for the morning before you go to bed. Doing what you can to organize your life will reduce stress.

No matter the way you write about it, be it by blogging, face booking, tweeting, or simply confining your thoughts into an electronic or paper journal, it's a good way starting point toward recovery. For me, it was a way to reach out to others, to talk with survivors and patients going through the same thing I was, and feel like I wasn't alone.

At first, I did it anonymously, it was easier for me that way. I was a little shy, even through the computer. Just like afreshchapter said, after I received a few comments, I got bolder and my posts and tweets started getting more precise, talking about issues that were important to me. Then, I decided I was ready to tell my own story, be open about my own experience and share my own "wisdom" about breast cancer.

The idea that my questions, my stories, even the time where I was ranting about my own misery, could help another fell less alone, know they are not the only one having good and bad days, give them an idea or two about how to go on living, fighting after this, it was worth it.

Go at it one thought, one idea, one comment at the time, but don't write about it. We all want to know, want to read and want to learn about others. It was makes us stronger. When I first started blogging, I told myself I didn't have to hit "publish" because it scared me to be vulnerable with my emotions. But, what I found is that after I pressed publish the first time and received a couple of comments, I would think about the 1 person who might feel less alone if I posted about my own experience. Even now, I try not to think about all of the strangers who have a window into my life and try to write each post for just 1 friend. Having an outlet to share my feelings has helped me through the roller coaster of post treatment life.

Therapy, relaxing hobbies, guided imagery, exercise. All these are really vital to your spirit, mind, and body. You control one thing; your thoughts. So stop living in a future you fear due to your thoughts and visualize what you desire. Also use meditation, laughter and relationships to help you. Drugs and alcohol are helpful too when the previous items are ineffective. As a 90+ year old said in our support group, "The only thing I am afraid of is driving on the parkway at night." You have a potential that you need to recognize and accept and live the message. As Ernest Holmes said, "What if Jesus was the only normal person who ever lived?"

I also use my smart phone to write in every single appointment, so I don't forget. I will do things to keep my brain active, such as learning a language and go grocery shopping without a list so I can help myself with recall. I also exercise. Keeping physically fit can help one feel better emotionally, so then chemobrain doesn't bother me as much as it can.

It is still a struggle for me, even 10 years after chemo. Just keep the mind and body as active as you can. My iPhone became my best friend. I keep all of my appointments (including my standing yoga appointment) on the phone calendar.

I did try the post it note route. The most important post it always got lost or was stuck to something so I started to write things down in one notebook. If I was out, I would record what I needed to do on the voice memo of my phone.

If a friend or relative asks me to help with something, I tell them they MUST remind me and the must NOT feel bad about calling me to remind me because quite a few times, I've promised to do things and completely forgotten. Now, I put it on the other person. I will be more than happy, just REMIND me. I do try to put everything in my calendar but some things just fall through the cracks.

I set my internet browser window to open to a blank page so I can't get distracted by some news story on my list of things that come up on my customized google page.

Numbers were a huge problem. I'm not so sure anymore because I stopped doing the high level accounting. I do still transpose them which is weird. I have to be careful with certain words. For whatever reason, the word: "fatigue" .... in my head, fatique...and now I'm careful with certain letter combinations. Writing sometimes flows another times requires ten reading before I'll pick up something that should have been obvious by the 2nd or 3rd read through. I enjoy writing so it doesn't bother me.

I have a horrible time staying on task. And a horrible time starting a task. And get overwhelmed when a "big task" has to be completed. I can't figure out how to break it into easier, smaller tasks. Plenty of times, I am WELL aware I'm on a deadline or I simply MUST do something and if I don't "have it" ... that's it.... I am going to have a friend come over to help me with a project sorting out papers.

That's horribly frustrating simply because I KNOW what I could do. Thinking on my feet to problem solve, multi task, answer emails.... check check & check.... and without mistakes-all at the same time. If this was a "gradual" loss of ability I would accept it far more gracefully. But it wasn't. It was like I ran right into a brick wall.

Haven't figure out how to solve that without medication and I don't want to go the adderall or provigil route. That's a tough one. Again, I can't even sit down for an hour every two weeks to pay bills. I have to set up auto bill pay.

I'm hoping a routine that is as simple as I can make it will help. I make sure I'm getting a good night's sleep and eat properly. I have my anxiety under control-between the yoga and a few coping mechanisms and a great therapist who I do see on a regular basis-sometimes weekly, sometimes skipping a week in between. Stress/anxiety are REALLY bad for that fog.

Stopped listening to anyone with a "solution." If there are three prominent doctors working at major cancer centers and they don't have an answer YET, and if the doctor who did my evaluation told me, "you've already implemented everything I would have suggested," there is no solution. It's just these "work around" solutions. I accept it and I hold on to the advice I've gotten from the medical people, "Do what you can, don't focus on what you can't." That is a problem for many women. If they can no longer function in the same capacity, a financial issue may arise. I am lucky that is not the case with me and I don't want to get on that path but I did want to acknowledge that I DO realize there are women who have suffered with salary issues.

I'm going to stop this one right there or I'll wind up writing a book!

The "general" tips that I give to patients are the same tips that I followed myself when I underwent chemotherapy for breast and ovarian cancer.
My tips begin by addressing what I think are the three major side-effects that patients find most distressing: alopecia, nausea and vomiting, and fatigue.

First it is helpful to understand why side-effects occur. Chemotherapeutic agents are drugs that attack rapidly reproducing cells such as cancer cells. Therefore, the rapidly reproducing cells of our body are also affected by the drugs. These include our hair follicles (alopecia), our skin (rashes), our digestive tract (nausea and vomiting),our bone marrow(decreased red cells causing anemia causing fatigue or decreased white cells causing infection).

Hair loss is predictable if given the drug(s) that cause alopecia. First and foremost, it is vital for the patient to know if they are receiving a drug that will cause hair loss. Some drugs cause thinning of the hair but do not actually cause complete hair loss. I inform the patient of which drug they are given which predicts hair loss. General tips I give them is to buy some scarves, hats, and wigs PRIOR to receiving their first dose of chemotherapy. It is always good to choose wigs when you have your hair so that you can match your color and style as closely as possible. Although some patients like myself choose to get different styles and play around a little! I suggest that if the patient has long hair that they may want to cut it short prior to the first dose of chemotherapy but it isn't a necessity because hair loss is predictable. Once the first dose of chemotherapy is administered hair loss will occur 14-17 days after the first dose. I therefore didn't cut or shave my head prior to chemotherapy. When I could pull out the first "chunk" of hair on day 14 is when I choose to shave my head. I was ready with scarves, hats, and wigs. Being prepared helped to decrease my overall anxiety about alopecia. I also tell patients that there hair WILL grow back after chemotherapy. It may be a different color and texture but it will DEFINITELY grow back. I also tell them that it only takes 3-4 weeks after the last dose to feel sprouts of hair!

Nausea and vomiting are most distressing but PREVENTABLE side-effects of certain drugs administered. Fortunately, now there are many antiemetic (anti-nausea) medications that are used to control both nausea and vomiting. It is very rare for vomiting to occur but those at high-risk are patients who got morning sickness with pregnancies or those patients who get car-sick or sick riding roller-coasters. Otherwise, the very important thing is to take the antiemetics as ordered, which most likely means to take them starting at the time of chemotherapy and continually thereafter for 2-3 days AFTER CHEMOTHERAPY AND AROUND THE CLOCK. The antiemetics are not as effective if they aren't taken until nausea and vomiting occurs. Prevention is the key. Take the medicines routinely as prescribed and usually even nausea can be prevented. Each chemotherapy regimen has specific antiemetic protocols to match the drugs being given. The doctor and nurse will know which drugs and which antiemetics and when to take them before, at the time of, and after treatment. Diet is another important facet to avoid nausea and vomiting. It is wise to not overeat the day of chemotherapy and for a few days afterwards. Small, frequent meals are advised to ease digestion. Avoiding spicey foods and irritants (smoking) will also decrease nausea and vomiting. Most important tip; take the medicines as prescribed because they work!

Fatigue is a major complaint for those patients undergoing chemotherapy. The fatigue can come from anemia caused by bone marrow suppression and decreased red cells. But there are now medicines such as Procrit to treat anemia and the nurse and doctor will be monitoring your blood counts on a weekly basis through treatment. Even so, chemotherapy is given in cycles (to allow those normal rapidly producing cells to recover) and general fatigue incurs possibly as a side-effect of all the cells being broken down in the body. I encourage patients to monitor their energy levels, especially patients that continue working or who are raising small children. Taking breaks from activity or taking short naps during the day can be rejuvenating. Believe it or not, research has shown that exercise transforms into energy! I encourage patients to walk during treatment. It doesn't need to be any exercise that is stressful or demanding. Even short walks around the block have been found to be beneficial. Lastly, and very important, is identifying the need for help with daily chores and daily responsibilities. While undergoing chemotherapy, many people will offer their help. It is important to take them up on it and save your own energy! Let friends and neighbors do some cooking for you,carpooling, or grocery shopping. I had one friend who every chemotherapy cycle left me a warm meal for my family on my front porch. I counted her as a blessing during a very difficult time. Fatigue can cause a change in normal activities but energy usually returns a few weeks after chemotherapy is stopped. I do warn patients that other symptoms of fatigue include the risk of depression and difficulty concentrating and staying on task. I tell patients to tell their healthcare team if they have these symptoms (although we always should be asking!).

There are other side-effects that will be closely monitored by your healthcare team. I tell my patients that there is a risk of infection during chemotherapy due to depression of bone marrow cells. There is a medication, Neupogen, that will be administered if white cell counts fall below normal. But even so, I tell my patients to avoid people with flu or colds during chemotherapy as their resistance and immunity is lower. I also encourage good hygiene.

Sloughing of normal cells of the digestive tract can cause anything from mouth sores to constipation to diarrhea. Some drugs specifically cause mouth sores and the nurse and doctor should tell the patient if they are getting that drug. If so, we encourage the patient to carry out good dental hygiene and keep the mouth moist with just a warm water rinse. Mouthwashes contain alcohol and they are drying to the mucosa.
Certain drugs, especially the new agents that are called targeting agents, can cause skin rashes. The rashes are unfortunate but often a sign that the chemotherapy is working. Rashes can be cared for with topical or oral antibiotics and good skin care.

There are always drugs that have specific side-effects such as nail changes or turning the urine red, etc. I try to educate the patient on each drug administered and the normal, expected side-effects so that the patient doesn't needlessly worry and so that the patient is astute in catching an abnormal side-effect, e.g., fever, to call the nurse or doctor immediately. The "general" tips that I give to patients are the same tips that I followed myself when I underwent chemotherapy for breast and ovarian cancer.
My tips begin by addressing what I think are the three major side-effects that patients find most distressing: alopecia, nausea and vomiting, and fatigue.

First it is helpful to understand why side-effects occur. Chemotherapeutic agents are drugs that attack rapidly reproducing cells such as cancer cells. Therefore, the rapidly reproducing cells of our body are also affected by the drugs. These include our hair follicles (alopecia), our skin (rashes), our digestive tract (nausea and vomiting),our bone marrow(decreased red cells causing anemia causing fatigue or decreased white cells causing infection).

Hair loss is predictable if given the drug(s) that cause alopecia. First and foremost, it is vital for the patient to know if they are receiving a drug that will cause hair loss. Some drugs cause thinning of the hair but do not actually cause complete hair loss. I inform the patient of which drug they are given which predicts hair loss. General tips I give them is to buy some scarves, hats, and wigs PRIOR to receiving their first dose of chemotherapy. It is always good to choose wigs when you have your hair so that you can match your color and style as closely as possible. Although some patients like myself choose to get different styles and play around a little! I suggest that if the patient has long hair that they may want to cut it short prior to the first dose of chemotherapy but it isn't a necessity because hair loss is predictable. Once the first dose of chemotherapy is administered hair loss will occur 14-17 days after the first dose. I therefore didn't cut or shave my head prior to chemotherapy. When I could pull out the first "chunk" of hair on day 14 is when I choose to shave my head. I was ready with scarves, hats, and wigs. Being prepared helped to decrease my overall anxiety about alopecia. I also tell patients that there hair WILL grow back after chemotherapy. It may be a different color and texture but it will DEFINITELY grow back. I also tell them that it only takes 3-4 weeks after the last dose to feel sprouts of hair!

Nausea and vomiting are most distressing but PREVENTABLE side-effects of certain drugs administered. Fortunately, now there are many antiemetic (anti-nausea) medications that are used to control both nausea and vomiting. It is very rare for vomiting to occur but those at high-risk are patients who got morning sickness with pregnancies or those patients who get car-sick or sick riding roller-coasters. Otherwise, the very important thing is to take the antiemetics as ordered, which most likely means to take them starting at the time of chemotherapy and continually thereafter for 2-3 days AFTER CHEMOTHERAPY AND AROUND THE CLOCK. The antiemetics are not as effective if they aren't taken until nausea and vomiting occurs. Prevention is the key. Take the medicines routinely as prescribed and usually even nausea can be prevented. Each chemotherapy regimen has specific antiemetic protocols to match the drugs being given. The doctor and nurse will know which drugs and which antiemetics and when to take them before, at the time of, and after treatment. Diet is another important facet to avoid nausea and vomiting. It is wise to not overeat the day of chemotherapy and for a few days afterwards. Small, frequent meals are advised to ease digestion. Avoiding spicey foods and irritants (smoking) will also decrease nausea and vomiting. Most important tip; take the medicines as prescribed because they work!

Fatigue is a major complaint for those patients undergoing chemotherapy. The fatigue can come from anemia caused by bone marrow suppression and decreased red cells. But there are now medicines such as Procrit to treat anemia and the nurse and doctor will be monitoring your blood counts on a weekly basis through treatment. Even so, chemotherapy is given in cycles (to allow those normal rapidly producing cells to recover) and general fatigue incurs possibly as a side-effect of all the cells being broken down in the body. I encourage patients to monitor their energy levels, especially patients that continue working or who are raising small children. Taking breaks from activity or taking short naps during the day can be rejuvenating. Believe it or not, research has shown that exercise transforms into energy! I encourage patients to walk during treatment. It doesn't need to be any exercise that is stressful or demanding. Even short walks around the block have been found to be beneficial. Lastly, and very important, is identifying the need for help with daily chores and daily responsibilities. While undergoing chemotherapy, many people will offer their help. It is important to take them up on it and save your own energy! Let friends and neighbors do some cooking for you,carpooling, or grocery shopping. I had one friend who every chemotherapy cycle left me a warm meal for my family on my front porch. I counted her as a blessing during a very difficult time. Fatigue can cause a change in normal activities but energy usually returns a few weeks after chemotherapy is stopped. I do warn patients that other symptoms of fatigue include the risk of depression and difficulty concentrating and staying on task. I tell patients to tell their healthcare team if they have these symptoms (although we always should be asking!).

There are other side-effects that will be closely monitored by your healthcare team. I tell my patients that there is a risk of infection during chemotherapy due to depression of bone marrow cells. There is a medication, Neupogen, that will be administered if white cell counts fall below normal. But even so, I tell my patients to avoid people with flu or colds during chemotherapy as their resistance and immunity is lower. I also encourage good hygiene.

Sloughing of normal cells of the digestive tract can cause anything from mouth sores to constipation to diarrhea. Some drugs specifically cause mouth sores and the nurse and doctor should tell the patient if they are getting that drug. If so, we encourage the patient to carry out good dental hygiene and keep the mouth moist with just a warm water rinse. Mouthwashes contain alcohol and they are drying to the mucosa.
Certain drugs, especially the new agents that are called targeting agents, can cause skin rashes. The rashes are unfortunate but often a sign that the chemotherapy is working. Rashes can be cared for with topical or oral antibiotics and good skin care.

There are always drugs that have specific side-effects such as nail changes or turning the urine red, etc. I try to educate the patient on each drug administered and the normal, expected side-effects so that the patient doesn't needlessly worry and so that the patient is astute in catching an abnormal side-effect, e.g., fever, to call the nurse or doctor immediately.

I agree with the above suggestions.

I will also add that you need to stand up for yourself. Do not be afraid to ask questions. Make sure your medical team knows how you are feeling. They can't help if they don't know. You deserve certain things as a patient and if you are getting them, you will be more in control. You may need someone to assist you, but, that's okay too.

It will get easier. Feeling like things seem out of control is an appropriate reaction to getting a cancer diagnosis. Your body is literally acting out. So, first of all, I think it's important to give yourself permission to feel out of control. Allowing ourselves to have all of our feelings, even the uncomfortable ones. After that, I think the best way to feel more in control is to focus on what is actually under your control. Here are a few suggestions:
1. Make a list of what is under your control. This is an opportunity to get really creative. If your body is cooperating, then you can control what you choose to eat. If you have the energy, you can control how you move. You can control who you talk to to. You can control the decision to take a break or throw yourself into a project. And, if all else fails, you can control the choice to breathe slowly and treat yourself with great compassion.
2. Write the list down. Make copies for your kitchen, your car, your office, and anywhere else you might need it. Put it on your phone, iPad, etc. Cut up the list and put the pieces in the a jar. If you're feeling stuck, grab one at random.
3. Recognize that you may need to add some new pieces to your support structure to help increase your sense of control. You may need to connect with a support group, a pastor or a therapist to help you develop new skills.
I hope that met your need. Please feel free to ask for more clarification.

I am going to give you a somewhat simple answer, because anger (and our personal history with anger) can be a really complex issue. So, please read these as general guidelines, with an understanding that some of these suggestions may not be a fit for your specific situation.
1. I first suggest that patients express their anger in a safe setting. That expression can be to me if we're in session and in writing if we're not. Talking and writing about our anger can help us express the feeling without engaging in conflict.
2. I also encourage my patients to engage in some kind of physical activity. This may be running or kickboxing to act out some of the energy of the anger, or yoga to reconnect with your own calm center.
3. Next, I recommend taking some time to see if the anger is a protective cover for other, more vulnerable emotions (I wrote about this in a post about what our anger covers up: http://bit.ly/oNalyA). If we're also feeling scared or insecure, our anger may be more intense.
4. I remind patients that anger is not the enemy. In fact, anger can be a good sign that something is wrong. Sometimes though, our anger isn't an appropriate response. In fact, it's totally possible to feel angry, even if you logically know that the anger isn't appropriate. This happens because our emotions and our logic come from different parts of the brain, and those parts of the brain aren't always on the same page. So, we need to be patient with ourselves as we look for the triggers to our anger.
5. Finally, as an overall life habit to help manage many difficult emotions, I strongly recommend some sort of meditation practice. There are many specific practices, so I encourage patients to experiment with several, so that they can find their best fit.
I hope that begins to get at what you were looking for! I am going to give you a somewhat simple answer, because anger (and our personal history with anger) can be a really complex issue. So, please read these as general guidelines, with an understanding that some of these suggestions may not be a fit for your specific situation.
1. I first suggest that patients express their anger in a safe setting. That expression can be to me if we're in session and in writing if we're not. Talking and writing about our anger can help us express the feeling without engaging in conflict.
2. I also encourage my patients to engage in some kind of physical activity. This may be running or kickboxing to act out some of the energy of the anger, or yoga to reconnect with your own calm center.
3. Next, I recommend taking some time to see if the anger is a protective cover for other, more vulnerable emotions (I wrote about this in a post about what our anger covers up: http://bit.ly/oNalyA). If we're also feeling scared or insecure, our anger may be more intense.
4. I remind patients that anger is not the enemy. In fact, anger can be a good sign that something is wrong. Sometimes though, our anger isn't an appropriate response. In fact, it's totally possible to feel angry, even if you logically know that the anger isn't appropriate. This happens because our emotions and our logic come from different parts of the brain, and those parts of the brain aren't always on the same page. So, we need to be patient with ourselves as we look for the triggers to our anger.
5. Finally, as an overall life habit to help manage many difficult emotions, I strongly recommend some sort of meditation practice. There are many specific practices, so I encourage patients to experiment with several, so that they can find their best fit.
I hope that begins to get at what you were looking for!

You've hit upon a very important topic and one that will become more and more challenging as the number of heavily treated survivors continues to rise. At the time of my treatment the physicians admitted they weren't sure what kind of long-term health issues I would face but felt the only way to even hope for survival was very aggressive treatment.

Bone loss associated with chemotherapy induced early menopause is problematic. I've taken calcium, Vit D and tried to walk regularly in an effort to keep my bones strong. Unfortunately that hasn't been terribly successful but has helped some. I tried an oral bisphosphonate but developed esophageal problems. Given some of the issues with IV bisphosphonates I've been reluctant to try them and my insurance doesn't cover them.

As a nurse, I'm hesitant to add medication to deal with those issues unless there is no other choice. Joint pain escalated to the point of needing an anti-inflammatory agent but again, walking regularly does help. Hot flashes can be an issue. Again, I tried an anti-depressant for a while and decided to keep a dietary record to determine if there were dietary triggers and have found some success changing diet rather than medication. Getting adequate rest and hydration seem to help as well.

I now have extreme sun sensitivity so limit my sun exposure and when out always use a 45-60 SPF sun block, sun glasses, hat and sun-protective shirt.

Often it's hard to know if symptoms are treatment related or simple part of the aging process. Following extensive chemotherapy it does seem that survivors may experience unexpected consequences and physicians aren't sure how to manage those.

Keeping active has been useful for me and having an understanding oncologist who will listen and explore ways to help me deal with continued questions related to my treatment. You've hit upon a very important topic and one that will become more and more challenging as the number of heavily treated survivors continues to rise. At the time of my treatment the physicians admitted they weren't sure what kind of long-term health issues I would face but felt the only way to even hope for survival was very aggressive treatment.

Bone loss associated with chemotherapy induced early menopause is problematic. I've taken calcium, Vit D and tried to walk regularly in an effort to keep my bones strong. Unfortunately that hasn't been terribly successful but has helped some. I tried an oral bisphosphonate but developed esophageal problems. Given some of the issues with IV bisphosphonates I've been reluctant to try them and my insurance doesn't cover them.

As a nurse, I'm hesitant to add medication to deal with those issues unless there is no other choice. Joint pain escalated to the point of needing an anti-inflammatory agent but again, walking regularly does help. Hot flashes can be an issue. Again, I tried an anti-depressant for a while and decided to keep a dietary record to determine if there were dietary triggers and have found some success changing diet rather than medication. Getting adequate rest and hydration seem to help as well.

I now have extreme sun sensitivity so limit my sun exposure and when out always use a 45-60 SPF sun block, sun glasses, hat and sun-protective shirt.

Often it's hard to know if symptoms are treatment related or simple part of the aging process. Following extensive chemotherapy it does seem that survivors may experience unexpected consequences and physicians aren't sure how to manage those.

Keeping active has been useful for me and having an understanding oncologist who will listen and explore ways to help me deal with continued questions related to my treatment.

I'd just like to add to be sure your drains are not left in too long. Please discuss this with your doctor PRIOR to surgery. Drains that are left in too long offer a greater chance for infection, scarring and unnecessary discomfort. If you do suspect you have an infection, INSIST that your doctor see you right away, do NOT wait for your next sceduled appointment. You may consider the emergency room if your doctor is in surgery and you need immediate attention Necessity is the mother of invention, they say. Patients find a number of ways to deal with the uncomfortable drains. Some doctors will help 'attach them' to one of the time-release-pain devices (my twin sister had a belt apparatus and her surgeon helped put the drains in this so they could be 'tucked back in' after she released the fluid in measuring cups and recorded the output). Saftey pins are the conventional solution for most patients but the real key (at least for me on the 2 occasions I had drains) was making sure they did not pull or tug because they can get very uncomfortable and itchy. If you can find a solution that will relieve them from pulling (the weight of the fluid as it drains can get a little heavy) on the skin where they are inserted, that has seemed to provide the most relief. There are specialty shirts with pockets sewn in that you can order and these give you a place to store drains. There are pockets that you can use that are self-adhesive and attach to your clothes (Pink Pockets) and I've even heard of people using a carpenter's apron and putting the drains in the pockets there. Some hoodie jackets have pockets inside. You will need to venture out to the doctor post-op (hopefully to get the drains out as soon as possible) and I felt well enough to venure out to Target after my surgery but the drains can be a real drag because you want to feel normal but these bulbs get in the way. You want to find a way to 'hide them' without having them pull more then necessary. A lot of patients have time to plan ahead and that would be my biggest recommendation - have your solution in hand before you go to the hospital because the drains are a real pain to have to deal with when you are already in pain and may be worrying about upcoming cancer treatments.

In my case,at age 47, menopausal symptoms presented itself as soon as chemotherapy was over although my periods stopped after my first cycle of chemo. I have hot flashes, vaginal dryness, and difficult sleeping. For hot flashes, I exercise regularly, eat healthy and wear layers. Bedroom windows are open all night, my husband has down comforter to help with our temperature differences. Vaginal dryness was painful and my oncologist recommended estring which works wonderfully. I occasssionally take melatonin for sleeping when I need to. Overall, my hot flashes have diminished or else I have gotten used to them. I'm so glad cool fall days and nights are upon us. That is a great question. Not doing well managing frankly. I drink a lot of water, exercise regularly, try to ensure my calcium and vitamin D intake is adequate. Hot flashes and night sweats really stink and taking a daily dose of Femara doesn't help. I tried the Chillow (chilled pillow - like the opposite of a heating pad - but it leaked all over my bed and smelled of vinyl). Cotton blankets and pj's help. Getting a decent's night of interrupted sleep has been very elusive but I'll take an occasional Ambien because it helps me sleep through the night sweats. Looking forward to hearing some other best practices on beating the menopause blues!

Like dlebleu, I was also lucky to have my partner of now 27 years by my side through my diagnosis. Fortunately for us we had established a great relationship of communicating over the years that helps us through any difficult time. That skill served us well during our battle with breast cancer. My advice would be to talk it out and talk through it. Share your feelings and your fears and remember that even though you might personally be dealing with cancer, your partner is dealing with a lot too. They are concerned about your well being, your medical care, and often take on additional duties around the house. Sometimes they might need to talk to someone besides you to express their feelings. Organizations like the Cancer Support Community and Men Against Breast Cancer offer support for caregivers and could be what your partner needs if they are having a difficult time. Like dlebleu, I was also lucky to have my partner of now 27 years by my side through my diagnosis. Fortunately for us we had established a great relationship of communicating over the years that helps us through any difficult time. That skill served us well during our battle with breast cancer. My advice would be to talk it out and talk through it. Share your feelings and your fears and remember that even though you might personally be dealing with cancer, your partner is dealing with a lot too. They are concerned about your well being, your medical care, and often take on additional duties around the house. Sometimes they might need to talk to someone besides you to express their feelings. Organizations like the Cancer Support Community and Men Against Breast Cancer offer support for caregivers and could be what your partner needs if they are having a difficult time.

I posted an answer before, but I don't see it...silly iphone! So please bear with me if the other post shows up and I repeat myself...

It is critical to ask others for help. Give them specific food tasks to do for you - running to the store, chopping veggies, bringing over a pot of soup. You've got to delegate. I found during my own treatment that people really do want to help - they just don't know how, and they're honestly relieved when you give them a specific role.

The other key item for me was to have a protein smoothie every single morning for breakfast - whether I felt like eating or not! I looked at it as medicine - part of my treatment. Cancer treatment does so much to our red and white blood cells, so it is critical to keep up strength as much as we are able.

There are many varieties and flavors of protein powder available from healthy grocery stores. For those who avoid soy, try rice protein powder. Here's a smoothie I made every morning:

2 tbsp. protein powder, 2 tbsp. flax seeds or chia seeds, a handful of spinach if you can tolerate veggies, milk of your choice, and an apple. Blend it all in a blender. And remember - delegate someone to pick up these things for you. Then all you have to do is chop the apple and throw it all in the blender. NOTE: Coconut milk can be very soothing to the stomach.

If you happen to have access to a juicer, try to juice veggies every day. This gets a little more complicated because you have to wash the veggies and then wash out the juicer. But if you live with someone else, perhaps you could delegate juicing to them.


I posted an answer before, but I don't see it...silly iphone! So please bear with me if the other post shows up and I repeat myself...

It is critical to ask others for help. Give them specific food tasks to do for you - running to the store, chopping veggies, bringing over a pot of soup. You've got to delegate. I found during my own treatment that people really do want to help - they just don't know how, and they're honestly relieved when you give them a specific role.

The other key item for me was to have a protein smoothie every single morning for breakfast - whether I felt like eating or not! I looked at it as medicine - part of my treatment. Cancer treatment does so much to our red and white blood cells, so it is critical to keep up strength as much as we are able.

There are many varieties and flavors of protein powder available from healthy grocery stores. For those who avoid soy, try rice protein powder. Here's a smoothie I made every morning:

2 tbsp. protein powder, 2 tbsp. flax seeds or chia seeds, a handful of spinach if you can tolerate veggies, milk of your choice, and an apple. Blend it all in a blender. And remember - delegate someone to pick up these things for you. Then all you have to do is chop the apple and throw it all in the blender. NOTE: Coconut milk can be very soothing to the stomach.

If you happen to have access to a juicer, try to juice veggies every day. This gets a little more complicated because you have to wash the veggies and then wash out the juicer. But if you live with someone else, perhaps you could delegate juicing to them.

That's great Sabine! My story is somewhat similar. I found it hard to find the right fit. I had some bad experiences with a large organization. Their loss.

When I lost my job I knew I wanted to get into non profit so I was looking to volunteer. I was extremely surprised that it was very hard to find volunteer opportunities. I really wanted to be at a breast cancer organization. I found an opportunity at the local chapter of the Leukemia & Lymphoma Society. It is a wonderful organization and I love volunteering there. I also got involved with the Metastatic Beast Cancer Network. That has recently led to a part time job. I couldn't be happier.

I'll add one thing to Sabine's advice, patience.
I just embarked on my Volunteer Career (I like that, it rhymes!) most recently. I was part of a clinical study at Sloan Kettering and I realized I was the beneficiary of someone's donation dollars. Then, I began to take part in a survivorship program and realized I was the beneficiary of someone else's skill and expertise because of their kindness in volunteering their time. I realized I needed to give back. I began poking around the hospital website to see how I might volunteer my time. And a new path began.

Local hospitals are great places to start. Nursing homes, too. (I have a hairdresser friend who volunteers her services a few hours a week). Googling for non-profits in your area and contacting them is another good avenue to find organizations that may be looking for volunteers. If you have a school aged child (or teen), the schools are likely aware of plenty of local organizations looking for volunteers.

There is no feeling better for me, than to know I made a small difference in the life of another, even if it was only for a short period of time. I stand in awe of some of the volunteers I have met at the hospital. Their commitment inspires me.

When I became pregnant after a mastectomy, I began to wonder if I could successfully breastfeed my child. I started asking everyone...the pediatrician, my obstetrician, the internet...the only one with a definite "Yes!" was my OB's nurse. She told me it would be no different from a mother with twins nursing her babies.

At the hospital, the lactation consultant told me to use a breast pump frequently at home to build up my milk supply. I also needed to supplement my baby's feedings with formula. My husband would give the baby a bottle and I would nurse the baby. By doing this, the baby didn't have nipple confusion. After two months, I was breastfeeding my daughter exclusively.

With my second daughter, I used a supplemental nursing system from Medela. When I ran out of milk, I would put formula in a bottle attached to a very small tube, which I put next to my nipple. The baby sucked on my nipple and the tube, stimulating my milk production naturally and also receiving formula, so that her sucking was rewarded. This method was frustrating to learn, but very successful once we got the hang of it! By the time the baby was one month old, we were breastfeeding exclusively. When I became pregnant after a mastectomy, I began to wonder if I could successfully breastfeed my child. I started asking everyone...the pediatrician, my obstetrician, the internet...the only one with a definite "Yes!" was my OB's nurse. She told me it would be no different from a mother with twins nursing her babies.

At the hospital, the lactation consultant told me to use a breast pump frequently at home to build up my milk supply. I also needed to supplement my baby's feedings with formula. My husband would give the baby a bottle and I would nurse the baby. By doing this, the baby didn't have nipple confusion. After two months, I was breastfeeding my daughter exclusively.

With my second daughter, I used a supplemental nursing system from Medela. When I ran out of milk, I would put formula in a bottle attached to a very small tube, which I put next to my nipple. The baby sucked on my nipple and the tube, stimulating my milk production naturally and also receiving formula, so that her sucking was rewarded. This method was frustrating to learn, but very successful once we got the hang of it! By the time the baby was one month old, we were breastfeeding exclusively.

I don't know if that fear ever totally goes away. I am four years post chemo and almost five years post mastectomy. In the span of a month (recently), I had myself in the internet pine box. Every weird episode and every ache and pain that is in a potential "mets" spot and I still have to talk myself off the ledge. I do believe it's definitely a form of PTSD and although it might get better, a cancer dx changes you and it changes you forever.

I found yoga about a year ago, too. That has helped. Pushing the thought out of your head isn't going to do the trick. At least it doesn't do it for me. I have to process the fear in the moment I am feeling it. Even if I KNOW I'm being completely irrational and illogical, feelings are just that. FEELINGS.. and the worst thing, for me, is to attempt to diminish the feeling. Or ignore it. I found when I do that, the damn thing takes on a life of its own and definitely becomes worse than ever and the fear is suddenly larger than life.

If I can't shake the fear and I realize I'm being a bit over the top, I will do things like blast a "feel good song" .... go grab a glass of water.... walk outside if it's a nice enough day..... sit on the yoga mat and do some gentle stretches.... And, honestly, if I can't get myself recentered, I use the anxiety medication. Fortunately, I don't have to use it frequently but if it's necessary, I will take something.

The fact that you are still experiencing pain isn't helping the situation. The pain in itself is a constant reminder so it's not difficult to just make that mental leap. I think as the pain subsides and it's less "in your face" these frightening feelings will become more manageable and will occur less frequently.

Yes, it does take time and it helps if you have a buddy (one buddy) who can help talk you off the ledge. I have a girlfriend who (last month) said, "you need an MRI" (I swore I had brain mets because of two unexplained falls in a 90 minute period of time). When I told her that I was NOT doing that, she switched gears and calmed me down. (She did monitor my "are you falling" in her own sneaky way for the next several weeks...) ....

Talking helps. I hope you keep reaching out. Coming here and just asking the question is a great step in a good direction.

All the best,
AnneMarie As a speaker, I often talk about the power of fear in our lives. Between my first and second diagnoses, I had a health scare that led me to believe that the cancer had spread and I knew if it had, I was in real trouble. My fear wasn’t dying but leaving my then 14-year-old daughter alone in this world to fend for herself. It was my absolute worst fear and one that, at the time, was too horrific to even wrap my mind around.
With the help of a counselor, I was able to actually face that fear and by doing so, I took away its’ power. You need to ask yourself, what if your cancer does come back? What does that mean for you? What will you do? Are you fearful of dying? Are you fearful of leaving your family? What other things about a second diagnosis scares you? Do you think you are strong enough to fight it? All these questions and a hundred more will surface.
When you have identified your fears, you must look at each one of those and break it down. For example, I was afraid to leave my daughter behind. I had told myself that because I had been a single mom and it had been just the two of us for so long, she wouldn’t make it without me. What I learned by looking at the fear closer and being more realistic about it, was that she had an excellent support system in place. I had a life insurance policy which would get her through college and then some. She still would have a great father and step-mother as well as extended family around to get her through the rough times. She was an outgoing child, so even though she might have to relocate, she would make new friends easily and most importantly, I knew I had already given her the foundation for which she could build the rest of her life. I knew there would be times in her life, during those monumental moments like graduation, marriage, her first child, that she would miss me and wish I were there, but I also understood that she would get through it, like countless others have. When I got to the other side of all the fear, it was clear that she would, indeed, be able to make it without me and there was now a plan in place, i.e. she would move in with her father; her extended family would surround her; and I put a trust together for her care.
Although, the process was the hardest thing I’ve ever done, it was also the most liberating because it taught me that fear isn’t real. The fear lost its’ power and I wasn’t scared anymore.
If you can ask yourself the questions above and answer them pragmatically, without the fear, the same will happen for you. There will be a plan in place and if you have to face cancer again, you will already have a roadmap for how to deal with it in place.
Let’s look at the big one. “What if I get cancer again?” Okay, what is the first thing you will do? My answer would be: Get a second opinion. “What if the second opinion says I have it?” My answer is: Then I will get my support system in place and I will begin to work with my doctor to decide my best option of care. “What if it is worse than before?” My answer is: I am a strong person and I have been through this before, so I know that I must take it one day at a time and do whatever I can to take care of myself the best I can.
This is the process you go through and it is so important to do so, because if you don’t, you could end up making some of your healthcare decisions based on fear instead of what is best for you. I truly believe anything you do out of fear will be the wrong thing.
I hope this has been helpful and I hope that by going through this process you can put your fear behind you. I think you will find that once you have done this, you will feel more empowered than you ever have.

A recurrence of the original primary tumor or a new tumor can be devastating psychologically - while many women understand that cancer can come back, no one expects it, just like most don't expect the original diagnosis. Take some deep breaths, and as noted above, face it head-on. Try not to let your emotions and fears get the best of you, and realize that science and treatment advances may mean better and more effective treatment options than were available to you previously. A recurrence of the original primary tumor or a new tumor can be devastating psychologically - while many women understand that cancer can come back, no one expects it, just like most don't expect the original diagnosis. Take some deep breaths, and as noted above, face it head-on. Try not to let your emotions and fears get the best of you, and realize that science and treatment advances may mean better and more effective treatment options than were available to you previously.

The first thing I'd say is that the notion of "normal" after treatment ends is something most of us yearn for but not something you can ever *really* attain -- especially if you're hoping to get back to the way things were before you found out you had cancer. Understanding this and learning how to cope with post-treatment recovery is crucial.

You have just been through an enormous trauma, and traumas always have consequences. It's very important to understand that, and to know that if you feel you need any kind of help dealing with the emotional aspects of recovery, you can start to heal if you get help. There are Oncology Social Workers, Therapists, and other kinds of qualified people who can help you deal with any aftershocks. Ask your doctor for referrals.

Understand that this is a very vulnerable time for you. Most likely you are wishing you could put it all behind you, most likely all the non-cancer patients/survivors in your life are not going to understand how you feel (don't hold this against them--they just can't, as they have not traveled in your shoes) and are expecting you to "be all done." Sorry, but you are not. Now begins the slow process of recovery. Be patient with yourself, be gentle to yourself, find a balance between pushing yourself and giving yourself time to rest. Connect with other survivors and learn how to live in the moment. You get through a difficult moment, you get through another, and next thing you know you've made it through the day, one step closer to your "new normal."

During treatment, your life is structured, you see your medical team regularly, you have a purpose and it can feel like a huge shock to all of a sudden be "out there" on your own. It's a relief to be done with treatment, but it can feel daunting too. Be aware that you might feel this way--I suggest finding things like a support group, an art-therapy or writing class, etc. through your Cancer Center to meet other survivors and share support. Also look for organizations such as http://www.cancersupportcommunity.org/ And, as well as TalkAboutHealth online, there's a wonderful "Breast Cancer Social Media" chat on Twitter every Monday evening. Follow the hashtag #bcsm and join the discussion. As a matter of fact, we recently addressed this topic!

Just remember that this "New Normal" can and will lead to good things if you are open to it. There is a light at the end of the tunnel, but it will probably take you a lot longer to get there than you expected, so settle down for the long haul and breathe deeply. I have done this three times; it might not be fun all the time, but it can be done, and IT DOES GET BETTER. The first thing I'd say is that the notion of "normal" after treatment ends is something most of us yearn for but not something you can ever *really* attain -- especially if you're hoping to get back to the way things were before you found out you had cancer. Understanding this and learning how to cope with post-treatment recovery is crucial.

You have just been through an enormous trauma, and traumas always have consequences. It's very important to understand that, and to know that if you feel you need any kind of help dealing with the emotional aspects of recovery, you can start to heal if you get help. There are Oncology Social Workers, Therapists, and other kinds of qualified people who can help you deal with any aftershocks. Ask your doctor for referrals.

Understand that this is a very vulnerable time for you. Most likely you are wishing you could put it all behind you, most likely all the non-cancer patients/survivors in your life are not going to understand how you feel (don't hold this against them--they just can't, as they have not traveled in your shoes) and are expecting you to "be all done." Sorry, but you are not. Now begins the slow process of recovery. Be patient with yourself, be gentle to yourself, find a balance between pushing yourself and giving yourself time to rest. Connect with other survivors and learn how to live in the moment. You get through a difficult moment, you get through another, and next thing you know you've made it through the day, one step closer to your "new normal."

During treatment, your life is structured, you see your medical team regularly, you have a purpose and it can feel like a huge shock to all of a sudden be "out there" on your own. It's a relief to be done with treatment, but it can feel daunting too. Be aware that you might feel this way--I suggest finding things like a support group, an art-therapy or writing class, etc. through your Cancer Center to meet other survivors and share support. Also look for organizations such as http://www.cancersupportcommunity.org/ And, as well as TalkAboutHealth online, there's a wonderful "Breast Cancer Social Media" chat on Twitter every Monday evening. Follow the hashtag #bcsm and join the discussion. As a matter of fact, we recently addressed this topic!

Just remember that this "New Normal" can and will lead to good things if you are open to it. There is a light at the end of the tunnel, but it will probably take you a lot longer to get there than you expected, so settle down for the long haul and breathe deeply. I have done this three times; it might not be fun all the time, but it can be done, and IT DOES GET BETTER.

Susan_Beausang:

One thing you might also consider is giving your mother as much freedom to make choices as possible. Often we think we are efficiently helping by anticipating a need and meeting it, but we are seen as being "controlling" and "intrusive." Whenever possible, tell your mother what you would like to help her with and give her an "either-or" option. Try having a conversation like this:

"Mom, I'd really like to do something for you today, if you don't mind. I could either take the trash out or I can move your chair to the spot you choose in your bedroom. Which would you like me to do?"

This places her in the director's chair and helps her assert her independence. Give it a try and tell us how it works. Susan_Beausang:

One thing you might also consider is giving your mother as much freedom to make choices as possible. Often we think we are efficiently helping by anticipating a need and meeting it, but we are seen as being "controlling" and "intrusive." Whenever possible, tell your mother what you would like to help her with and give her an "either-or" option. Try having a conversation like this:

"Mom, I'd really like to do something for you today, if you don't mind. I could either take the trash out or I can move your chair to the spot you choose in your bedroom. Which would you like me to do?"

This places her in the director's chair and helps her assert her independence. Give it a try and tell us how it works.