Breast Cancer and Mental Health

Every year during the month of October I write a blog for Chrysalis Center for Counseling regarding the importance of Breast Cancer Awareness. This topic is very important to me because I am one of the 1 in 8 U.S. women that will develop breast cancer over the course of their lifetime.

In 2012 at the age of 31 I sat across from my doctor and heard the words I would never forget “you have breast cancer”.  The word Cancer carries so much weight in itself that it was hard for me, in that moment, to see beyond it. When I could finally process what was happening, I realized I had a choice, I could either curl up in a ball and fall fast into depression or I could pull myself together and make cancer wish it never knew me.  I chose to pull myself together and fight and that is exactly what I did.

Breast Cancer totally changes your sense of “normal.” It may impact your ability to do your job, spend time with your loved ones, or go about your daily routine. And while the physical impacts of breast cancer and its treatments are well documented, the impacts on a patient’s mental health are just now being recognized and researched.

Because more and more breast cancer survivors are starting to speak up about their struggles with mental health issues, I felt compelled to honor their voices. Here’s what you need to know about breast cancer and mental health.

Diagnosis and Treatment Side Effects

Breast cancer can bring a mixture of emotions. The impact of a cancer diagnosis and ensuing treatment on a person’s mental health can be significant. A cancer diagnosis and treatment can lead to mood disorders (depression, worry, and anger), hopelessness, and changes in body esteem. Breast cancer treatment can bring side effects such as insomnia, memory changes and mood swings. Hormone level changes can influence your emotions, and weight gain can be discouraging. Some women self-blame while others feel punished. Studies show that most people diagnosed with breast cancer will subsequently develop symptoms of PTSD, and these symptoms tend to last longer than a year.

You may have heard about “chemo brain.” Chemo brain describes problems with thinking (cognition, memory, attention) that may occur as a result of receiving chemotherapy to treat cancer. These symptoms may affect patients during or after cancer treatments. Emotional and mental health problems that survivors may face can also contribute to difficulty with thinking and learning.

After a breast cancer diagnosis, a woman’s relationship with her body may change. While lifesaving, mastectomies can decrease a woman’s body confidence and have a negative effect on their overall mental health. For better or for worse, breasts are deeply tied to identity and self-esteem in American culture that for many women, losing one or both of their breasts is a lot to process mentally.

Fear of Recurrence

Fear of recurrence is common and expected after a cancer diagnosis. Any physical symptom, even a cough or minor pain, can trigger the fear of a cancer recurrence. It is important to always notify your doctor of any new concerning physical complaints. However, sometimes the fear or recurrence can be out of proportion to the physical complaint or thoughts become intrusive or distressing.  Every ache and pain may cause you to think, “Is my cancer back?”

Your Emotions Matter

There are ways to help ease you or your loved one’s fears and anxieties after a cancer diagnosis.

• Accept your emotions. Talk about your feelings with a healthcare provider, licensed mental health professional, trusted friend, or other survivors.
• Practice mindfulness or meditation. Awareness in the moment often helps reduce anxiety, stress, and fear of recurrence.
• Take control of your health. Ask your doctor for a written follow-up care plan, including what exams you need in the future and how often you should have them.
• Recognize important indicators. Ask your doctor for a list of symptoms you should report to him/her in between check-ups.
• Maintain a healthy lifestyle. getting enough exercise, sleep and eating a healthy diet.
• Join a support group.  Getting to know other cancer survivors will help you feel less alone as you learn how they are coping with the same worries.

• Feel your feelings You have a right to mourn your losses—but remember, you are more than your cancer. Be gentle with yourself. Look for ways to feel good inside and out. There are many options available to help you: prescription medication, counseling, acupuncture, massage, meditation, relaxation techniques and physical therapy, among others.
• Avoid the “be positive” trap. It’s completely normal to have bad days. But, if you find that your anxieties, worries, or fears are interfering with your day-to-day activities or sleep habits, talk to your doctor.

Mental Health Resources

Cancer patients and survivors may feel like it’s more difficult to talk about mental health problems and struggles. It may be because family members or friends don’t talk about mental health, cultural beliefs don’t support having mental health discussions, or they feel that they should be “strong” or “brave” and keep it to themselves.

Anyone struggling with these issues should never feel embarrassed about seeking out mental health support. You won’t need it forever, but it can help during this time.

Here are some resources to help someone psychologically get through cancer.

• Caregiving (CDC)
• Feelings and Cancer (National Cancer Institute)
• Cancer Support Groups (National Cancer Institute)
• Memory or Concentration Problems and Cancer Treatment (National Cancer Institute)
• Caregivers and Family (American Cancer Society)

I can’t tell you that my breast cancer treatment and the days, months and years following my diagnosis were always easy, I had my share of bumps in the road and experienced my own mental health struggles. Finding the strength to finally reach out and ask for support was life changing for me and I look back now and wish I had done it earlier.

If anyone you know is experiencing mental health struggles after a cancer diagnosis and are afraid or ashamed to ask for help, please remind them it is ok to take care of themselves…they deserve it!

Because May is Mental Health Awareness Month as well as the month we celebrate Mother’s Day, I decided to write about how all us mothers need to let it go!

It is becoming increasingly important for moms to take care of themselves and protect their mental health. Juggling the demands of motherhood and employment not only have a mental, but also an emotional impact on our mental health. One that we do not like to talk about, and normally ignore as we keep glorifying the “motherly sacrifice” expectation that is built into our society.

We are faced with increasing demands on our time, energy, and sanity, it has become harder and harder as a mother not to fall victim to the temptation of constantly pushing ourselves to keep up the appearance that we have it all together.  We drive the kids to soccer practice, to dance class, and attend PTA meetings, all while maintaining the household and for many, also working a full-time job. As a mother we feel we must appear to be unstoppable and able to handle any task thrown at us because that is the expectation.

But who gets to set these expectations? Why do we feel that we must keep our homes, our families and ourselves looking a certain way, at the expense of our own sanity? Why do we feel the need to prove that we are a “perfect” mother?

 The truth is there is no such thing a perfect mother….. AND we do not have to keep it all together.

We do not even have to keep any of it together. What we must keep together is our mental health.

We need to take the time to check in with ourselves and take a minute to breathe and reset. As mothers we are so busy checking in with everyone else around us and making sure others needs are met, we forget to hit pause and take time for just us.  Letting go of the need to keep it together is hard. It’s going against all the messages we’ve been indoctrinated with at a very early age. It’s going against the very voices of our mothers, sisters, and friends. I am guilty of thinking that if I missed a PTA meeting or choir concert, I would be judged and considered a “bad mom”.

But self care is not selfish and at the end of the day this is what will allow us to be less stressed and more present with our families. When we let go of society’s/other’s expectations of us, we are able to create the version of motherhood that works best for each of us and will provide years of amazing memories for our children.

I have added some of my favorite quotes about motherhood, I hope they make you smile and I hope all of the mothers out there have a Happy Mother’s Day!

“Patience: What you have when there are too many witnesses.” @rebel circus

 “My kid is turning out to be exactly like me. Well played, Karma. Well. played.” -House Wife Plus

“Sure, sometimes I question my parenting. But to be honest, sometimes, I question my child’s childing.” -Just Surviving Motherhood

 “Listen, maybe 17 pairs of black leggings do spark joy, Marie Kondo. You don’t know me.” -Just Surviving Motherhood

Every October since I joined the Chrysalis family, I have been asked to write for our blog and share pieces of my journey with breast cancer to promote awareness and early detection. This year, however, it was my idea to write for our blog because I wanted to share a side of surviving cancer that no one talks about and before now, I was not ready to share.

In 2012, at the age of 31, I sat across from my doctor and heard the words I would never forget “you have breast cancer”.  The word “Cancer” carries so much weight in itself that it was hard for me in that moment to see beyond it. When I could finally process what was happening, I realized I had a choice, I could either curl up in a ball and fall fast into depression or I could pull myself together and make cancer wish it never knew me.  I chose to pull myself together and fight, and that is exactly what I did. I cannot tell you that it was always easy, I had many bumps in the road, nevertheless, after countless doctor appointments and 12 surgeries, I am cancer free and have been given the title “Survivor”.

Almost immediately, after my cancer diagnosis and my initial surgeries were complete, I started speaking and volunteering at as many breast cancer events as possible. Although I had always participated with these charities, I felt a new pressure to pay it forward. I thought I owed it to all of the others battling cancer since I had it so much easier. I also began to experience insomnia and anxiety symptoms and found myself obsessively relieving the day I was diagnosed. I would think about that day step by step every single day. I thought about it while I was driving to work and while I was on vacation with my family. Despite the persistence of the thoughts and memories, I never addressed these issues or thoughts with any of my doctors.  I assumed it was normal. I told myself that since my cancer was caught early and I survived I should just deal with these issues. After all, I did not have nearly as bad as other individuals diagnosed with later stages of cancer so I did not have the right to complain. I should just be grateful.

A few years after my diagnosis I received a phone call that Toni, one of my closest friends and biggest support systems during my cancer battle was diagnosed with late stage ovarian cancer and it was terminal. I remember immediately breaking down, not being able to catch my breath and saying, “She is too good, it should be me”.  Toni fought an incredibly brave battle and when she could fight no more, gained her wings. After she passed the thought of “it should have been me” turned in to “why wasn’t it me” and that thought was not just directed at my friend’s battle but at anyone that did not survive their cancer battle.

I was no longer experiencing just insomnia and what was became debilitating anxiety, I became completely disconnected from friends and family. I would go through the motions, but I felt completely empty inside. I was not just reliving my diagnosis at this point; I was constantly questioning why I had it so easy and why did I get to live. Any time I would express these feelings to family or friends they would be minimized or dismissed. I would be told that I “shouldn’t feel that way.” I eventually decided I would just keep these feelings and thoughts to myself.

I would do my best to hide these feelings and play the part around others like I knew I should, but I was not ok.  I began feeling compelled to follow stories on social media about families documenting their terminal cancer journeys, most of these being about children. I felt like it was my responsibility to show these families support during what was the worst time in their lives. I was really punishing myself for not suffering enough and surviving.

One day my friend asked me why I was constantly following “those sad stories” and I told her “I needed to experience the pain, difficulties, and loss other cancer patients not as lucky as me go through to actually be worthy enough to be a “real” survivor.  I will NEVER forget the look on her face after that response, and that is the moment I knew I needed to get this figured out. I began seeing a therapist to figure out why I was no longer myself and why I felt crazy. What I learned was that I in fact was not crazy and that all the emotions and symptoms I had been experiencing were actually Cancer-related survivor guilt.

It may come as a surprise to those who have not experienced cancer, to learn that many of us suffer a sense of “survivor guilt”.  Cancer-related survivor guilt is a complex, multi-faceted emotion. Not only can we feel guilt at “surviving” when others have not, but we may also feel that because we have been diagnosed with an earlier stage disease, or that we didn’t have to go through chemotherapy we are somehow less “deserving” of sympathy.

Luckily the stigma surrounding survivor’s guilt seems to be lifting, thanks to a nationwide shift in the way the public thinks and speaks about mental health in general. More Mental health professionals are starting to speak on this topic and oncology professionals are starting to recognize it so if their patients are suffering with this guilt, they can offer them resources and support.

For me, knowing that survivor’s guilt is not only real, but exists in many emotional forms was my first step in overcoming it. I have learned that when it comes to navigating life after cancer, it is important to realize that no two paths are the same. Every cancer journey is different, and I need to be grateful for the good things I have. If I have an off day, instead of dismissing or being ashamed of my feelings, I need to acknowledge and accept them.

I chose to share this aspect of my cancer journey in hopes anyone else that may be experiencing these thoughts and feelings can rest assured that what you are experiencing is real and you can’t always “just get over it.” That it is ok to get the help and support you need. I want survivors coping with these emotions to know that you are loved, you do not need to justify your existence and you deserve to be here.

Because it is breast cancer awareness month, I was asked if I would tell my story about my journey with this disease. I, of course, said yes and was honored to do so since this disease affects thousands of women and men across the globe; the more awareness that is out there – the better. But, as I started writing this I had the realization that each person’s cancer diagnosis and journey is as distinct as the person it affects, and how they recall this journey is just as distinct.  

This is my story.

On the morning of Tuesday February 21, 2012, I sat alone on the examination table in Dr. Charles Scott’s office at Wilmington Health. I wasn’t there because I needed a physical or I had a cold, I was there because the week prior he had performed a breast biopsy and it was time for the results. He had already come in and checked my biopsy incision and stated that “everything looked good,” and then promptly excused himself for me to get dressed so we could go over the pathology. It may not have been a red flag for others but because I have worked in healthcare my entire career I knew that if I was really 100% fine, he would have told me so when he checked the biopsy site and there would have been no reason for a second chat.  I knew the next time he walked in to my room I was going to hear a word that no one is ever prepared for and even though I had hoped I was wrong, the pit in my stomach was telling me to prepare myself because my life was about to be forever changed.

Dr. Scott came back in my room after a few minutes and this time instead of stethoscope he was carrying a piece of paper and his nurse Angela was with him. He looked me in the eyes and asked, “ready?” I remember slowly nodding my head “yes” even though I was definitely not ready. “Ductal Carcinoma In Situ” was his next statement to me because that was what the pathologist found in my biopsy. But, behind those big words was the real diagnosis…breast cancer. I do not remember everything that Dr. Scott said to me while I sat on his examination table because I was intent on not breaking down in tears, so I kept telling myself to “hold it together ” and “don’t you dare cry.” My mind was busily trying to accept my diagnosis and everything that was about to follow. I remember thinking how I was only 31 years old… I had a full-time job…. I was a full-time college student only three courses away from completing my MBA…. and most important, I had two small children at home so who was going to help my husband raise them if I died? My mind also went back and reviewed the last six-month journey that brought me to this very spot and how I had actually hoped to get here just not with the same ending.

In September of 2011, I was sitting on my couch when suddenly, I had this weird sensation run from the middle of my left breast to under my armpit. It was not a painful feeling just a very odd one and, in that moment, I had a powerful thought “you have cancer.” At first, my mind went to “what a crazy thought” but at the same time I had a pit in my stomach because breast cancer has affected every generation of women in my family and it has always been a worry hidden in the back of my mind that I too would pull the unfortunate short straw and be diagnosed with this disease. To ease my mind, I scheduled an appointment the next week with my gynecologist and when I explained the sensation I had, as well as my family history with breast cancer, I was certain that my request for a simple mammogram would be instantly approved. I was expecting him to appreciate being proactive and order the test even if to just to ease my mind. He instead patted me on my knee and told me that I was just being overly paranoid and that no mammogram was needed because I was too young to have breast cancer and no insurance would cover it. I left that office feeling shocked and unheard, but I was not yet defeated. The following day I scheduled an appointment with my PCP to get a second opinion believing that even though I did not feel heard the first time around, I hoped this doctor would hear me out and take my concerns more seriously. Two weeks later when I went in for that second opinion I told my doctor the same thing: the sensation I had, my family history and my request for a mammogram. I was unfortunately told very similar statements as before: “too young”, “your family history is not that bad”, and “no mammogram is needed”.

I wish I could tell you that the third time was the charm but unfortunately it was not. Neither was the fourth. I spent the next five months “doctor shopping” for a mammogram. I even went as far as calling a local radiology office and ask if I could pay cash for a mammogram, but their answer was “no” because special testing requires a referral from a medical provider. I honestly could not believe that it was really this difficult to get a mammogram! I feel this is the point where I started to lose hope and began to feel defeated. Defeated as a patient and defeated as a woman. But even in those low moments I knew that I had to keep going and make someone hear me.

About two weeks later, I was at work in my office when one of my medical assistants came in and asked if I was still looking for a new doctor. I told her I was, and she told me how amazing her PCP was then urged me to call her. I took down the information, but I was a little reluctant to call and go in because I wasn’t sure if I could handle being dismissed by yet another physician. I gathered my hope and made the call to Dr. Catherine Daum’s office at Wilmington Health later that day and scheduled an appointment with her later that week. Walking in to Wilmington Health for the first time was a little overwhelming but as soon as I met Dr. Daum, I knew I was in the right place and this was going to be different from my other appointments. Dr Daum listened to all my concerns and feelings and without any hesitation ordered a mammogram. I cried tears of joy in her office because someone finally listed to me and was willing to help me! This is what I had hoped for and was so thankful and knew that my hope had led me to the right physician. One week later I went in and received the mammogram that I hoped for and a few days later I was back in Dr Daum’s office being told a mass had been found and that she was referring me to Dr. Charles Scott, a surgeon with Wilmington Health who specialized in breast biopsy/cancer. I met with Dr. Scott for the first time a few days later and he too listened to everything I had to say and then asked me if I wanted to revisit the mass in six months or have him perform a surgical biopsy, I choose the biopsy and the rest is history.

Back to Dr. Scott’s office just being told I had cancer …… 

Once I was able to focus again I found Nurse Angela with her arms wrapped around me and Dr. Scott (attempting to take some of the shock away) making a reference to movie that I had never seen. I interrupted his movie reference and asked him what my options were. After he reviewed them with me, I opted for a bilateral mastectomy. When I asked if I could get on his surgical schedule ASAP, he told me I’d be in surgery that Friday. I left his office knowing that I now had to tell my husband, children, family and friends about this new chapter all while staying strong and having hope that everything was going to be alright.  I knew there were only two options, the low road or the high road and I refused to fall in to a pit of depression and let this diagnosis win. I didn’t have time for that. I can’t say that I was not scared because I was, but my faith and hope was stronger than any fear. Three days later on February 25, I had my bilateral mastectomy and was officially cancer free.  Four months later I had my reconstruction and while there were some complications in between I never lost my hope that everything was going to be OK. Perhaps not perfect – but OK.

I am six years cancer free and I celebrate every February 25th as my cancer birthday. It has not always been easy, I had to make so many difficult decisions and my life is forever changed, but I am alive and here with my family and I even graduated with my MBA on time.Everyone who is diagnosed with cancer is a survivor, I just hope that I can inspire people going through similar situations and they can see this is what the face of cancer can look like. If I could choose one word to describe my journey, it would be hope because that is honestly what carried me through. More importantly I want people to understand the power of hope and to hold on to it even in the most difficult of times.

Sarah Snyder is the Practice Manager at Chrysalis Center.