Tag: Body Image

Cancer Survivorship Ain’t For Sissies

With all the focus on breast cancer during October, pushing us to be warriors and fight our way through this, the concept of survivorship can get lost in the fray.

We talk about cancer treatment and get very granular about the procedures, whether surgery, chemotherapy or radiation therapy. And those do deserve a lot of discussion as they can be difficult to endure. Some, like chemo, have an almost legendary reputation and it’s important to be able to separate fact from fiction.

After all the noise and attention associated with cancer treatment, survivorship can leave some of us feeling alone.
Photo by Atharva Tulsi on Unsplash

Consider: how many of us, upon hearing that we have breast cancer, preoccupy ourselves with worrying about what life will be like five years down the road? More likely, we’re thinking about what treatment will be like and are hoping that we’ll be around when it’s done!

But with so many women surviving breast cancer, it’s important to talk about what happens after the dust settles and you realize you’re on the other side of the treatment that you had so feared. Is it really the “other” side?

So much of my blog has been devoted to the life after cancer. After I documented my treatment journey, I turned around to get hit in the face with all the stuff that I wasn’t expecting.

One of those was endocrine therapy. Women with hormone receptor positive cancers aren’t done when the “tough stuff” is over. Tamoxifen and aromatase inhibitors are a whole new round of treatment that can affect your hair, your libido, your joints and more. Some women get hot flashes and night sweats. Some experience weight gain. And these are medications intended to be taken for a number of years.

There may be body image issues. Breast cancer surgery can leave women looking very different from their pre-cancer days. Like it or not, breasts are associated with womanhood. Whether lumpectomy or mastectomy, with or without reconstruction, there is a new normal that needs to be dealt with.

By seeking support and relating your story, you help not only others who are dealing with something similar in addition to yourself.
Photo by Ivana Cajina on Unsplash

And then cognitive issues like distractibility, loss of memory and difficulty processing concepts may come up. To make things more complicated, these may appear after treatment is in our rear view mirror and our loved ones may simply not appreciate what we’re dealing with. The bodies and minds of survivors may change in a way that they are not prepared for. Because, how do you anticipate something like this?

Survivorship does not mean that you never again have to think about cancer or its repercussions. There will be adjustments to your expectations as to how your life will be from now on. It’s important that those around you understand that just because you are done with the major cancer treatments, things might not feel familiar or normal.

So we need to be having this conversation with those around us and making opportunities for affected women to seek help and support. There is no shame in being a survivor who is also struggling. While it’s true that we are “lucky to be alive”, it does not mean that we have no right to seek a higher quality of life.

Don’t be afraid to talk about it. ❤

Invisible Effects: Libido, Where Art Thou?

I was warned about this. I mean, where do you want to start counting the reasons for libido to take a hike? Anxiety of a cancer diagnosis, fear of losing breasts (the societal hallmarks of femininity), chemotherapy (which pretty much kills everything), tamoxifen (blocks estrogen, so there go the hormones)…

Out of all the things touched by breast cancer and its treatment, this is one of the most personal that not only affects the patient but also the one you love, because it throws a monkey wrench into your relationship. As with many of these “invisible effects” of cancer, this one is not discussed enough, but really should be.

A marriage that is strong should survive this. A marriage that is new or rocky may take more damage. Married your wife mainly because she had long blonde hair, lovely breasts and looked good in your Porsche? Uh-oh. Stories circulate about the high percentage of divorces that result from lack of adherence to the “in sickness and in health” part of marriage vows. I’ve read that those statistics are inflated, and yet, it’s hard to ignore confirmed instances of, “he didn’t find me attractive anymore,” or “she no longer wanted to have sex with me.”

Emotional isolation is a real possibility following cancer treatment if you’re not communicating effectively with your significant other.

In my experience, all the effects of cancer dropped onto your libido won’t necessarily squash it into oblivion. But they do add a degree of difficulty in maintaining intimacy. There is nothing normal about having cancer, and so it’s not surprising that it wrings the “normal” out of a marriage. Communication is critical, and if things are going to break down, I think that’s where it’ll happen.

It’s not that there wasn’t desire throughout my cancer treatment. It’s that it was hard to Tetris sex into the chemo schedule, when I was dead tired and feeling like the lining of my GI tract had sloughed off. Hubby was taking care of the kids and I was lucky if I could make it to the toilet by myself. Perhaps desire was there, but any available energy was better utilized for self-care.

Chemotherapy left me feeling very “neuter”, in that gray area between female and male. Being scrawny and bald didn’t help. I didn’t look feminine and felt even less so. My reality was fuzzy, as if I had one foot in this world and one in the next, which wasn’t the greatest recipe for firing up desire. We went through about a year of unintentional celibacy and that took a lot of discussion to patch up.

Now in survivorship, sexual intimacy has taken a backseat to the rest of life. I mean, I’m still alive, so I’d better make the most of it, and languishing in bed is not where I want to be. I’ve spent enough time supine. Weekdays I need to get the kids ready for school and get myself to work. On weekend mornings, there are workouts to do, posts to write, meditations to finish, coffee to brew. If there are insufficient hormones to drive me into the arms of my beloved, then he’s left to get a few extra hours of sleep while I get on with life. Once in a while, we reconnect, but we’re behind the curve on this.

At the same time, intimacy is an inextricable part of a healthy long-term relationship. I am not giving up on finding my mojo again, but as with everything in cancer recovery, it’s going to take time.

Invisible Effects: Body Image, Part 3

In Part 1 of this series I wrote about breast loss (which I ended up not having to deal with) and how strongly I equated breasts with being female. In Part 2, it was about my fear of having no control over my body and being susceptible to weight gain as a cancer survivor.

In Part 3, I’m writing that my body reacted in a way completely opposite of what I feared, and I managed to regain some semblance of control.

As mentioned, many women with breast cancer, particularly those whose tumors are hormone receptor positive like mine, put on weight. On top of the “my-out-of-control-body-is-killing-me” feelings brought about by cancer, the threat of runaway weight gain added to my frustration.

Yes, this was another example of how, throughout my fact-finding research, I took to heart what I read and immediately assumed that if it happened to others, it was also going to happen to me. Except that it didn’t. Just as how statistically I shouldn’t have gotten breast cancer, I also shouldn’t have ended up almost 10 pounds below where I started pre-diagnosis.

My body is quite reactive. If you’ve read my posts about how I respond to anxiety, you know that I shed weight quickly. I am not an emotional eater; I am an emotional non-eater, and more often than not don’t have to fight cravings. I have to fight a lack of appetite

As weird as this may sound, the resulting weight loss was one of the strongest indicators that I wasn’t completely out of control, that my body hadn’t completely turned against me. And more than that, it was another reminder that my situation was not typical. So by maintaining a very doable 6 day/week workout schedule, I broke through the mentality that what others experienced was necessarily what I would.

Right side of my ribcage. I can see my serratus and external obliques, but have to focus on building strength, not losing weight.

In addition, and arguably more important is the fact that cancer recurrence and episodes of lymphedema have been associated with higher weight levels (see this Susan Koman web article addressing this issue, including journal references). According to a bioelectrical impedance analysis (BIA) body fat monitor, I’m sitting at about 20% body fat. The actual number doesn’t really matter, since these monitors are notorious for being inaccurate. What matters is that those numbers are stable and that I’m able to build muscle.

What also matters is that with my level of activity both pre- and post-diagnosis, recovery has been quite good. I feel strong. I feel lean and fit. My sense of self-efficacy is high. And I’m finally able to exhale after holding my breath about all the things that were happening to my body.

Piece by piece, I’m reclaiming my physical self again. At that same time, I’ve still got a lot to sort out in my head. I know that keeping my body fat in check doesn’t mean that I’m protected from cancer, despite what numerous news reports suggest. It makes me uncomfortable being bombarded with that message, though. According to the December 20, 2018 National Health Statistics Report (Fryer et al. (2018)), the average woman in the U.S. is obese. In the interest of public health, the “lose weight” message is trumpeted constantly. Every time I’m exposed to that, my perfectionism kicks in and I have to fight the urge to clamp down on my fitness and nutrition.

Being an outlier doesn’t gain me much sympathy, and it does comes with its own challenges. In the process of sorting out everything that’s happened to me, I’m working to keep an even keel going forward and not go to extremes. As with everything, moderation.

Invisible Effects: Body Image, Part 2

Oddly enough, one of the things that scared me about cancer was that it threatened all the work I’d put into my body. Being a bit under six feet tall since my teenage years, I was called “big” a lot whether or not I was overweight. At 16, I went through a phase of disordered eating. That passed, but I retained a sensitivity to how I was perceived by others. Always, I was fearful of being judged, and that pushed me towards perfectionism.

Fast-forward to 2017 and my diagnosis. When I started researching breast cancer, one thing that struck me was that the information I found didn’t mesh with my conception of what cancer was, in terms of what the treatment did to the patient. I had always thought of cancer treatment as having a wasting effect on the sufferer. But then I read of the propensity that many breast cancer patients had for putting on excess weight, not only throughout chemo, but also due to taking estradiol-blocking medications like Tamoxifen.

Wait, what? Gaining weight? But I’d always thought that cancer patients lost weight! Sure enough, google “breast cancer weight gain” and you get a lot of entries from reputable sources that warn about this tendency to pack on weight. My Nurse Navigator echoed that point, noting that many women “put on 10-15 pounds.”

Many decisions in my life have been motivated by a fear of being judged.

This provoked a lot of frustration. I had established excellent diet and fitness habits for the very purpose of building strength and endurance and avoiding the weight gain that accompanies advancing age. I had kept emotion out of my food choices (kudos to my mother for being careful about not connecting food and emotion). During my time as a stay-at-home-mom, I’d obtained a highly-respected personal trainer certification because I wanted to be sure I knew what I was talking about. My standards were high, but even if I couldn’t attain my version of “perfection”, I put in 100% effort and that made me feel good.

And then, cancer. Despite doing everything I could think of to maintain peak health, I still had not been able to prevent the development of my tumor. That was extremely unsettling. But for me, having my whole body shape change as a result of this was almost worse.

Predictions of the future raced through my mind: I was going to lose my lean mass, lose my fitness and put on ten or more pounds. I would be judged for “letting myself go”. None of this would be under my control. Just like the cancer, it was all happening to me, and as far as I was concerned it was bound to ruin my life, whether or not it actually killed me.

However, as with so many other things related to my cancer, this didn’t go the way statistics predicted. And that’s why there’s a Part 3 to this body image series…

Invisible Effects: Body Image, Part 1

This is going to take several posts to get through. Body image is a dicey subject for me.

First of all, let’s talk breasts. Mine are not very big to begin with. Okay, they’re teeny. That usually doesn’t bother me although there have been times that, standing 5’11”, I’d wished that I’d had a more sizable bustline. Most notably, this was when I was toying with the idea of competing in fitness-based figure competitions; ultimately, I decided to stay away from the extreme dieting and arbitrary body judgments that came along with these contests.

Regardless, breasts were an important part of giving figure competitors an attractive, balanced look. But at such low body fat levels, breasts were collateral damage. So what the dieting took away, silicone gave back. I found this odd because no matter how hard these women worked to achieve the “perfect” physique, according to the judges (and society) they couldn’t pull it off without something artificial. We have a powerfully ingrained notion that breasts = femininity.

I hadn’t realized how much I bought into the notion that I needed breasts to define myself as “female”.

When I learned that I had breast cancer, one of my first thoughts, right after, “Am I gonna die?” was, “Will I lose my breast?” The diagnosis left me empty, but thoughts of disfigurement drained me even more. There were different possibilities for surgery, different conditions under which I’d lose more or less breast tissue. And they were all stressful. I mean, I had little breasts, but they’d nursed two children into toddlerhood and I was remarkably attached to them.

And if I needed an entire breast removed, would I opt for reconstruction? Is there even such a thing as an AA cup implant? Or would a larger implant push me into getting the other side done too, for the sake of symmetry? As you can see, I was wading into excessive-surgery territory.

Finally, if I didn’t get reconstruction, would I get freaked out by a flat ribcage where my tiny-but-now-incredibly-important breast had been? Furthermore, would my husband, accepting and loving as he was, be turned off by a missing breast?

True to form, I had died a thousand deaths before finding out that I could get by with a lumpectomy. And because of the small size of the lump and where it was situated, close to my armpit, it hardly changed my breast at all (as noted in my post about breast changes). So all the worry was for naught.

But many women have not been so lucky. Emotional aspects of breast loss, reconstruction, lack of sensation and societal pressures are not discussed nearly enough but can have a powerful impact on the psyche of cancer survivors. And this drives home the point that cancer is complicated far beyond the cold, clinical elements of treatment choices and survival rates. Breast cancer gets at who we have been taught that we are as women. Re-evaluating that, and possibly re-examining it as a society, will take a lot of work.