When Grief is Messy: 3 Lessons Learned (Plus a Bonus)

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When Grief is Messy

I work with cancer patients and go through the ups and downs of diagnosis and treatment with them. Having recently lost my father-in-law and previous to that, lost family members to unexpected causes, I understand that grief can be messy. 

Earlier this year, for reasons prior to my own recent loss, my relationship with grief started to shift. I miss people I’ve lost but I’m starting to accept that grief and loss are a natural part of life. While it matters how the person passed away and whether I had a chance to say goodbye, their physical absence is permanent and nothing I do can change that. I still feel saddened by their loss, but the grief feels calmer, more settled. Through my lived experiences and the witnessing of other people’s grief journey, I’ve come to three lessons learned. 

There’s no one way to grieve

When I listen to jazz, I’m reminded of dad. While washing his clothes, I teared up. We bought a used RV and he had previously questioned whether that was a good idea. I’d speak quietly to him, saying, “Dad, we’re going on an adventure”. I talk to other people about missing him. I want to be with others but I also want to be alone. 

My husband uses dad’s old keychain and will wear one of his Hawaiian shirts to our friend’s wedding tomorrow. He says he feels his feels but he doesn’t bring up dad. He has a quiet resonance to my sharing. There was a time when I wasn’t sure if he was distracting himself or avoiding his grief. I couldn’t tell, but I also need to trust his words for it. 

Grief doesn’t look any one way and it doesn’t need to. How we choose to honor the memory of those we’ve lost is very specific to us as individuals, so let’s not insist that we must cry at funerals or else it means that the person didn’t matter to us. Or, it’s a celebration of life, so no tears allowed; only happy memories. Or, how can you book a trip to Disneyland when it overlaps the deceased’s birthday, favorite holiday, or death anniversary? That’s so heartless!

How we grieve is how we grieve. How others grieve is how they grieve. Let’s not judge. 

When one grief leads to another 

The thing is, grief is messy; it’s not linear. I even intentionally mixed up the stages of grief in a previous post about cancer. Not only is grief all over the place, it also connects our hearts to other losses in ways we least expect it. 

While sad about dad, I was reminded of his sister whom we lost to cancer a few years back. Then I started missing her. As if it’s contagious, my mind shifted to an uncle on my MIL’s side of the family and we lost him almost eight years ago! My heart was whelmed over. WTF, I thought I’ve grieved the loss of these people! And I have, but that doesn’t prevent my heart and mind from making these connections. I was missing them all over again, and for a moment dipped into the pain of those losses.

It’s okay to cry again, to be surprised by your own emotions, and to replay the sound of that person’s voice in your head. Deaths are significant, no matter how long they’ve been. So take a moment and let your emotions run. The word “emotions” contains the word “motions.”

Your emotions need to move. Let them move from the inside out.

Grief happens when it happens and lasts as long as it lasts

As you can imagine, death doesn’t wait for you to be in between jobs, for your kid to be off to college, for there to be at least a five-year gap from when you last experienced a loss. Neither does grief. Grief happens when it happens. I was writing this blog and started to tear up. You can be reading a receipt and be reminded of your son’s hockey jersey number. We would need to stop watching most shows if we don’t want to be triggered by death and dying. It doesn’t take much for grief to surface and when it does, let it be. 

Grief also lasts as long as it lasts. When asked how long is my sister, my wife, my dad going to grieve, grief expert David Kessler answered, “How long is the person going to be dead? If the person is going to be dead, they’ll be grieving for a long time.” The first two years are merely the early stage of grief. Mature grief is when we live out the rest of our lives without that person. 

So, if those five days of bereavement leave didn’t do anything for you, that’s because it’s better than nothing and yet completely insufficient. Your friend got over their partner in a year and remarried and you’re still a puddle on the floor? Their grief is their business and your grief is yours. 

Let your own grief journey take you to your healing.

Bonus: Remember how you remember

If there’s no one way to grieve, there’s no one way to remember. However you choose to remember your loved one is right. And when you want to switch up your ritual, it’ll be right then too. Going fishing is a great way to grieve, as is riding on Space Mountain or eating curry fish. You don’t have to wear sackcloth and ashes to be considered legitimately grieving, though no offense if that is you. Only you would know if you’re grieving, so do you.

An invitation to grieve

My hope for you is that you may stay present with your grief and take some time with it. If you need help through the grieving process, you know where to find us. 

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice. She helps unhappy couples find safety and connection in their relationship. She also helps cancer thrivers and their caregivers integrate cancer into their life stories. She remembers her friend Molly when she sees creepy art and eats Heirloom oranges. She celebrates her aunt when she eats dim sum. May you find your ways too.

Caregivers: Two Factors to Keep in Mind when Caring for a Cancer Patient

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Caring for a loved one going through cancer is taxing. You’re used to seeing this person as strong, independent and capable. For perhaps the first time, they’re physically weak, emotionally shut down and have a hard time pulling themselves up. They’re cranky when they used to be the most patient person in the world. They’re tired, they sleep a lot, they’ve lost weight, gained weight, they don’t want to eat their favorite foods, they can’t do what they used to...

And, worst of all, you can’t make things much better for them.

You try to be there, to help out in whatever way you can, to remind them of how great they’re doing, how much you care… But none of these change the fact that they’re still suffering. You can’t take their exhaustion, their nausea, their discomfort away. You perk up when you catch glimpses of their old self before fatigue takes over and they have to climb back into bed. Seeing cancer suck the life out of them makes you angry and it breaks your heart.

Because the word cancer is often equated with death, aka the ultimate out-of-control experience, there is a tendency to want to take back control. For caregivers, this can come in the form of doing too much or sometimes not enough. As a Medical Family Therapist, I learned that there are two important elements to keep in mind as the caregiver of someone going through a medical crisis like cancer.

Agency

The first is agency, defined as the ability for the patient to make independent and empowering choices about their life. If you’re feeling out-of-control as the caregiver, just imagine how your loved one must be feeling in their body. The last thing you’d want is for them to feel even more powerless over their situation. Provided they’re of sound mind to do so, decisions should be made by them, with them and along side them, rather than for them.

Choose your battles. Both of you are already battling cancer and that’s tiring enough. If they have a preference that’s irritating but nothing more, let them have their way. If they have a strong opinion about how they receive care, express your concerns but respect their wishes. Their life is still theirs even though it’s hard to watch because you want something better for them. They have their reasons for certain choices, even though you might not understand or agree.

Communion 

Aside from agency, a desire for communion, that is, a sense of belonging and being with their community, is also very important. Just because they disagree with you about what supplements to take does not mean you step away from their care all together. They might still need someone to fend for them at the next oncology visit, or you still make great company even though you’re doing nothing more than watching a show together.

Cancer patients often feel very alone, like they’re the only one going through cancer. While they may find that sense of camaraderie at support groups, you’re the one who has been there before cancer and now during cancer. You know they’re more than their cancer and you want to see them through. You’re the one who will love them through all of their changes and still find them beautiful.

Seattle resources

Caring for a cancer patient can be very isolating. It is important for you to pay attention to what you might be needing to sustain care. If you’re a caregiver needing support for yourself, Cancer Lifeline and Cancer Pathways are two wonderful organizations in the Seattle area with support groups for caregivers. There you’ll likely find others who also share your exhaustion, frustration, sadness, pain and guilt around caregiving. There you might also discover your need for communion during this trying time.

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps unhappy couples find safety and connection in their relationship. She also helps cancer thrivers and their caregivers integrate cancer into their life stories. You can find her at ada@peoplebloomcounseling.com.

Speaking up for Yourself as a Breast Cancer Patient

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October is breast cancer awareness month. While there’s often a lot of noise around screening and prevention, I want to talk about finding your voice when you’re at your oncology appointments. I work with a lot of breast cancer patients who wished they had requested this or asked that question during a medical visit, but it didn’t occur to them until after the fact or they may have felt unsure of themselves. And it’s difficult to broach that topic now that the appointment is over. 

Healthcare is changing

Gone are the days where doctors have all the authority and knowledge and patients come in and are told what’s wrong with them and how to fix it. Granted, I’m not saying don’t trust your medical team; they still have a lot to offer during a time of medical uncertainty. But, with the blessing and curse of search engines, you can easily look up symptoms, possible diagnosis, treatment and side effects, and seek medical consultation to confirm or deny your findings. While this might lead to misdiagnosis or unnecessary anxiety, now more than ever, patients are more likely to present at their doctor’s office looking more like this: “You recommended six rounds of chemo, but a recent study published in the New England Journal of Medicine found that women like me with early-stage breast cancer may not need chemo after all. What’s that about?”

Collaborative healthcare

The field of medicine has been calling it “collaborative healthcare.” As the name suggests, every time you go into your doctor’s office, it is really meant to be a collaboration, a partnership to a healthier you. You’re the one who has been living in your body for the past however many years; you’re the one who knows your medical history or have the means to find out whether there has been a history of cancer on either side of your family.

As a patient, you have something to offer too.

The thing is, when you feel heard, understood and your questions answered, you’re more invested in your treatment, and you’re more likely to follow recommendations that make sense to you. While you might not be thrilled about treatment itself, you can look forward to seeing your medical team because you know they care about you and have your best interest at heart.

Current reality

The reality is that there’s still a power differential between the provider and the patient. Your oncologist did go to med school and further specialized in cancer. Your degree was in business; not oncology. There is a firehose of information shared during appointments and on handouts, not to mention the emotional turmoil of needing to go through treatment. As a cancer patient, you are at a more vulnerable place. Rather than being told you need to jump and how high, this is a crucial time to find your voice and feel empowered about your own care. It is after all your body.

A push for self-advocacy

Because you’re such an important part of the treatment process, I strongly encourage you to advocate for yourself. If you’re not in a place to do so, bring a friend or a family member with you who could. The following are examples of ways to help you find your voice as you interact with your oncology team:

1. Do a little research, if that could help you – Emphasis on “a little”. Google does not replace medical school and decades of experience, but credible websites can help to learn a little about what might be going on with you. I say this with the caveat: for some people, knowledge is power. For others, knowledge is anxiety. Still for the rest, knowledge is power up to a certain extent, then it turns into anxiety. So, do what helps you.

2. Know your rights as a patient – This is the two page handout I call snooze reading. You can pick one up at any healthcare provider’s office and it shows you your rights as a patient seeking medical care. To name a few, you have the right, according to your local health department, to say yes to treatment, to say no to treatment, to change providers, to have access to records, to file a complaint, etc. You have more rights than you know. While you might fear ramifications for some of these actions, the stress of not being in charge of your own care could be worse.

3. Read your reports – It’s a lot of medical terminology, I know. Unless you’re also in the medical field, it can read like french. That’s the beauty of Google, you can search for terms, struggle to know what it really means, then proceed to 3) and 4). I know an oncologist who thanks his patients for reading their reports, because many people don’t.

4. Come with questions – You do have questions, even if you’re afraid of the answers. Your $135 visit with your surgeon is the best time to ask them. I know of a patient who goes to her appointments with her list of 20 questions. And, she brings her partner to catch the answers that goes over her head. Better to ask a silly question than to wish you had asked it after the fact.

5. Ask follow-up questions – Even for the over-prepared, there’s bound to be questions that are left unanswered. Secure message your doctor’s office in between appointments; you don’t have to wait until your next visit, unless your appointment is soon and you’d prefer a face-to-face.

6. Ask yourself, “What do I need or want?” – Being diagnosed and treated for cancer is a very uneasy time. Your world has just been overhauled. It’s okay to ask for what would put you at greater ease. Could a warm robe bring comfort during your next check up? A blanket during your four-hour chemo? Do you want to bring your special stuffed animal to every radiation treatment? Request a certain radio station during your MRI?

7. Ask for what you need or want – As you come upon your preferences along the way, share them. Make it happen. I know someone who asked for a surgical pen so she could go home and mark on her husband. Cancer is hard enough; let’s bring some lightheartedness into the mix.

Cancer has a way of prompting us to re-evaluate life, which could include finding your voice. You’ll never have as much medical attention given you than when you’re in active treatment. While it’s not necessarily the attention you’d like, let it be a time when you can focus on you.

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps unhappy couples find safety and connection in their relationship. She also helps cancer thrivers and their caregivers integrate cancer into their life stories. She’s a big proponent of standing up to your medical provider, even if it’s uncomfortable in the moment. After all, when you’re already diagnosed and treated for cancer, what do you have to lose? Please take care of you.

“Will my Cancer come back?” 9 Triggers to Fear of Recurrence

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The bad news and the good news, in that order

As a cancer thriver myself, the bad news is that these thoughts, “Will my cancer come back?” will always there. Whether I’m thinking about cancer or not, these thoughts are easily triggered. More on this in just a bit. Now the good news is, just because I think these thoughts does not make them happen. Ever tried thinking and willing really hard about winning the Powerball? Did you get rich just from thinking it?! If you did, we need to talk. 

A metaphor

The thing is, the thoughts of cancer coming back will be a part of your life. It’s what you do with those thoughts that matter. One cancer patient gave this metaphor, paraphrased: “Cancer used to take up a lot of room in my house (aka life). It was in every room. Everywhere I looked, it was there. Over time, as life continues, it takes up less and less space, until it only occupies one room. 

Sure, the fear of cancer coming back grows bigger around doctor appointments or when I have symptoms I don’t recognize. But the truth is, that fear is never gone. However, it doesn’t have to take over my life.”

Couldn’t have said it better. This wise woman has already given examples of common triggers to the fear of cancer recurrence. Let’s look at others. 

Know your triggers 

1. Your Cancerversary – it’s the anniversary of an important moment in your cancer journey, be it the day of your mastectomy or your last day of treatment. While it’s a cause for celebration to have that behind you, it’s common for your mind to wander to the possibility of recurrence

2. The news of someone else’s diagnosis – it doesn’t even have to be you. It can be a dear friend, a family member, a co-worker, a neighbor or even someone you don’t have a relationship with, a celebrity, a friend of a friend’s. Someone else’s diagnosis or recurrence is enough to have you question your own

3. Someone you know passed away from cancer 

4. Follow-up care – you’re scheduled for your follow-up examination, mammogram, MRI or blood test. While everything came back normal previous years, could this be the year that they found cancer?

5. Your body feels “off”– you feel fatigue, a lump or pain. Or, you have a lingering headache or cough. Your body is going through something. Whereas before you’d attribute it to muscle tension, sleep deprivation or dehydration, you now think cancer metastasis or brain tumor

6. A history of cancer recurrence – as can be imagined, if this is not your first rodeo, then it makes sense to wonder, “If it happened once and it happened twice, will it happen a third?”

7. Future medical procedures – whether it’s your reconstruction surgery or something unrelated to cancer, if you’re going under the knife again, it’s hard to not associate that with the last time you’ve received significant medical treatment 

8. Advances in cancer care – it can even be a good thing. Fred Hutch received a grant to advance cancer research. The immunotherapy clinic at Seattle Cancer Care Alliance is lengthening survival rates for certain types of cancers. Even the mentioning of these wonderful advances can trigger the thought, “I don’t ever want to have to go through that again!” 

9. Everything else – when visiting a friend at the hospital, the smell reminds you of your daily radiation visits. A woman is wearing breast cancer pink. A song that frequented your mind during treatment comes through the radio. You’re eating food that made you want to throw up during chemo. The truth is, sometimes it doesn’t take much. 

“Will my cancer come back?” 

The short answer is: we don’t know. Your oncologist might have given you percentages for how likely your type of cancer will recur or a new bout of cancer will develop. Let’s just say the number is 25%. That still leaves 75% of you not receiving a diagnosis of cancer ever again in your lifetime. How about living in that 75%? Better yet, since we really don’t know, why not go all out and just live in the 100%?

If you need help living fully in the face of these triggers, I’ll be here.

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps unhappy couples find safety and connection in their relationship. She also helps cancer thrivers and their caregivers integrate cancer into their life stories.  She recently gave a talk through Cancer Lifeline about Living with the Fear of Cancer Recurrence. Helping people live full and meaningful lives in the face of adversity is her bread and butter. Well, more like sushi and wasabi.

Happy Cancerversary to You!

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So I don’t actually know when your Cancerversary is. I only know that October is Breast Cancer Awareness Month. However, I’m guessing you’ve identified your Cancerversary, perhaps without knowing it. Do you remember the day, or even the moment you were diagnosed with cancer? The difficult conversation you had with your family? Your first core needle biopsy procedure? You surgery? Your introduction to the radiation machine? Your last day of chemo?

If you can lock down that date, that memory, then you have a Cancerversary. 

Cancerversary defined 

A Cancerversary is a significant day along your cancer journey. No doubt, cancer is a difficult ordeal; I can imagine there being multiple dates that define your cancer experience and not just one. Ultimately, a Cancerversary is what you make of it. While you didn’t choose cancer, you can choose what to do with these milestones. 

Though I do have a bias...

Celebrate often

I have a friend in his 40’s who celebrates his birthday by the months. Not kidding you. At 44, he was 528 months old, and so forth. Sometimes, we don’t even need to wait until the year mark to hear how many months old he is. After all, if babies go by months, why did we stop? Perhaps it’s because we’re not very good at math. 

Sure, anniversaries are often joyous occasions. They are also moments where we remember loved ones who have gone before us. While the initial diagnosis of cancer reminds us of death, the fact that you’re reading this means you’re alive.

No right or wrong way to celebrate 

Ask ten women how they’d like to celebrate their Cancerversaries and you’ll get at least 11 answers. Some treat it like any other day. Some set up a special date with their partner. Others attend a cancer support group. Still others make a trip out of it with their gal friends. 

It might involve a journal. Being outside. Some art piece. The color pink. Being inside. Special treats. Your favorite movie. Ultimately, it doesn’t matter. It’s your day. 

Today matters

If you’re alive today, could today be worth something? After all, it has been 39 months and 14 days since your hair started falling off. Or 76 months and 3 days since treatment ended. Whatever your numbers are, today is about you breathing and living your new normal. Today can be a full day. What would you want it to be about? 

If you’re having trouble living fully in face of cancer, it doesn’t have to be that way! You don’t have to be triggered by your Cancerversary or struggle to live meaningfully other days of the year. Let me know how I can help! 

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps unhappy couples find safety and connection in their relationship. She also helps cancer thrivers and their caregivers integrate cancer into their life stories. Now 22 months and 15 days since her cancer diagnosis, she celebrates each day. More recently, she has been delighting in the changing colors of the fall season. Her favorite leaf color is orange.

When Depression & Anxiety Come with Cancer

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Let's face it. It's enough to go through cancer diagnosis and treatment, let alone the emotional ups and downs that often come with it.

Questions that might trouble you

As a result of your cancer, sometimes you have questions about the past: "Did I do something wrong to cause this cancer? Could I have prevented it?" "What if I had __________________ before it got to be too stressful? Would that have made a difference?"

Other times you might have questions about the future: "My neck hurts. Is that cancer?" Will I be able to see my granddaughter graduate from 2nd grade?" "How will my family be without me?"

While it's normal to ask these questions, often times there really isn't a way to answer them. These questions might linger if you struggle with depression and anxiety. 

Depression and anxiety post cancer

What we know from cancer research is that depression and anxiety are common symptoms during and post cancer treatment. While depression might dissipate with time, anxiety lingers as you're reminded of your cancer everyday. 

Some of these symptoms might be treatment related, but could this be you? 

You might be struggling with depression if you experience the following: 

• feeling down, depressed or hopeless
• having little interests in things you used to enjoy
• sleeping too much or too little or have trouble falling asleep or staying asleep
• having low energy 
• having little appetite or want to empty the fridge
• feeling irritable 
• experiencing mood swings 
• having trouble concentrating 
• withdrawing from friends and family 
• feeling hopeless, guilty and/or angry
• having thoughts about being better off dead or hurting yourself 

You might be struggling with anxiety if you experience the following: 

• feeling nervous, anxious or on edge
• feeling like you cannot stop or control your worries
• finding yourself worrying too much about different things
• having trouble relaxing
• feeling restless and it's difficult to sit still
• feeling easily annoyed or irritable 
• anticipating worse case scenarios

Sometimes anxiety is felt in your body. You might be struggling with panic symptoms if you experience the following: 

• pounding heart 
• sweating 
• trembling or shaking
• shortness of breath 
• feelings of choking
• chest pain or discomfort
• nausea or abdominal distress
• dizziness/light headed
• chills or heat sensations
• muscle tension 
• feel out of control 
• fear of going crazy
• fear of dying

Life after cancer

If you identify with these symptoms that go beyond an occasional sad day or feeling stressed out about something, there is hope! You don't have to settle and let cancer drag your down. Rather than cancer driving your life, you can make meaning choices in the face of cancer. That way, depression and anxiety symptoms, even when they arise, won't bother you as much. 

If you need help putting cancer in the passenger seat, I'll be here. 

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps unhappy couples and cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about couples and cancer, she is cognizant about choices that make for a meaningful life. This often involves food. 

The Guide to Surviving Breast Cancer Screening and Diagnostic MRI

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Last month, I wrote about the guide to surviving mammograms. When your breasts* are temporarily smashed, to the point where you didn’t think they could be flattened any further, there is nothing fun about that. Breast cancer patients tend to talk about surviving cancer and not about getting through these imaging appointments. Today, I’d like to touch on ways to survive a diagnostic breast MRI, which is sometimes used in breast screening to supplement a mammogram.

Breast Magnetic Resonance Imaging (MRI)

Breast MRI uses powerful magnets to generate detailed pictures of your boobies. You’re to lie tummy down, hands over your head on a moveable flat table, with your boobs hanging into an opening. After you’ve been situated as comfortably as possible on this hard, narrow table, you, along with the table, will slide into a large cylinder-shaped tube. This procedure will last approximately 18 minutes, during which you’ll hear a constant sound of jack hammer, with some breaks in between. You’re to hold completely still to insure accuracy. Once inside the tube, you’ll feel alone in a tight space.

You might be given the choice of music to occupy your mind, but the music would have to be really loud to drown out the construction noise. Near the beginning of the scan, a contrast material will be injected into your arm through an IV to help outline breast tissue details. The technologist will speak to you through a speaker if any communication is to be had. These 18 minutes can feel like forever. How can you survive it?

Do’s and don’ts during a breast MRI

DO ask a friend or family member to come along. Even just knowing that your loved one is near can be comforting.

DON’T be afraid to ask questions or interrupt the process if something is really bothering you. The technologist can help you adjust your position or let you take a break as needed.

DO focus on your breathing. Notice the natural rising and falling of your body as you lay there. Come back to your breath over and over again.

DON’T scratch an itch or move around. If you pay close enough attention, you will feel some level of discomfort. Unless you're in pain or you're super uncomfortable, know that these feelings will pass.

DO close your eyes if it can help forget that you’re in a tube. Instead, imagine you’re in open space.

DON’T tense up your muscles. Notice when you feel tension in your body, from your face, arms, shoulders, torso, gluts to your legs. Invite relaxation into those muscles and let your body fall heavy on the table.

DO hum or speak softly to yourself. You can hardly hear yourself but you can feel what you’re saying. Soothe yourself with your own voice.

DON’T say to yourself, “I can’t wait for this to be over!” This will likely lead to further impatience and frustration. Your scan will take as long as it takes.

D0 think about what you plan to do to reward yourself after you leave the clinic. Perhaps it is a, “Jenny, you did it!” or a mocha waiting for you down the street.

DON’T try to calculate how long it has been. Chances are, it hasn’t been as long as you think.

Bonus tip on surviving a breast MRI: self-touch

No, I’m not asking you to think kinky thoughts as you lay inside an enclosed tube. Rather, remember your arms overhead? Your hands could be touching each other. In fact, before the machine starts, bring your hands to touch, one on top of the other. Feel the warmth of your hand, the texture of your skin. Notice what it is like to be touched, to be cared for, to be comforted, by you. Much like the touch of a loved one can help lower your cortisol level, so here you are, lowering your own stress level because you’re loving you.

Loving yourself through cancer

It’s hard enough going through cancer, your body does NOT need another, “Hurry up and get this over with!” moment. Instead, consider how you can love yourself through it all. If you need help getting through cancer care and life thereafter, let me know!

*Breasts are used in plural form with full awareness and respect that this might not be true for everyone

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about couples and cancer, she has found yoga to be a wonderful practice to nurture present moment, self-love and self-compassion. She has grown pretty fond of her toes recently. She says hi to them every time she passes them by.  

The Guide to Surviving Breast Cancer Screening and Diagnostic Mammograms

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Surviving cancer

Let’s face it. When breast cancer patients are in the thick of their cancer diagnosis and treatment, they’re just trying to get by. Surgery, radiation and/or chemotherapy all require recovery periods. The side effects of treatment are very real and some of them lasting. Many breast cancer patients are simply taking it a day at a time, trying to survive.

Having survived cancer, it is then interesting to note that some of the patients I have spoken to have a hard time with the screening and diagnostic tools such as mammogram and breast MRI. While they might be grateful for the accessibility of screening and early detection of cancer recurrences, they dread going to those appointments. Since regular mammograms and in some cases MRI might be recommended as routine care, is there value in talking about how to survive not just the cancer, but also follow-up care?

Whether you’re walking into your second mammogram or your 20th, I present to you a two-part series on how to survive these screening and diagnostic imaging appointments. Please note I’ll be using breasts in the plural form; I understand we do not all have two breasts and I’m cognizant of that.

Mammogram

Mammo: I recently heard this term and I consider it a euphemism for mammogram. Call it whatever you want, but it is not pleasant. A technician cues you to stand against a large machine as she operates slides and squishes your boobies into pancakes from various angles. X-ray images are taken of your flattened boobies and checked for abnormalities. If you’re going in for a diagnostic mammogram, more images will be taken and magnified for accuracy. In other words, more pancakes.  

While cancer patients tell me they’ve been instructed with all kinds of creative things to do as they bare their boobs against the mammography machine, you don’t hear this one very much: “Lean in(to the machine) like you love it!” That would be quite difficult to do considering the circumstances. However, there are ways to get through that moment of pain and discomfort. Let’s call it mindfulness, distress tolerance and self-compassion.

The mindful way through a mammogram

Mindfulness is about making space for the experience you’re about to enter into, paying attention to it, moment-by-moment. Usually when the experience is pleasant, we have no problem jumping in. However, when you’re about to get your chest temporarily flattened, it’s harder to accept the experience without resisting it and being with it as it is. Here are some ways you can practice staying present during a mammogram.

Feel the Robe

First of all, let’s backup and see if you can ask for a warm robe. Whether you’re getting a mammogram in the middle winter or the heat of the summer, a warm robe feels nice. We often associate warmth with comfort. Why not take a moment and feel into that warmth? The robe is there to keep you from the cold air in the room. Let’s take a moment to acknowledge what it’s doing for you.

Experience your breath

As the technician is setting up the machine and pulling up your record, take the time to ground yourself by focusing on your breath. Your breath is your anchor. Feel the rising and the falling of your chest. Perhaps notice the cold air coming into your nostrils and the warm air as it leaves you. No one breath is the same. Take some time with your breath. You’re alive because of it.

Sense your pain

This may seem contrary but as your breasts are being flattened, feel into those sensations. Your body is experiencing pain for good reasons and it’s sending you signals. The technician will often use a dial to tighten the slides together and you will experience an increase in pain with every turn. See if you can notice where you’re feeling the pain. Take it all in. Feel the tension, then feel the release when the slides separate again. Notice how when you enter into your pain rather than avoid it, it still hurts, but you learn to not be afraid of it. You are co-existing with it and watching the sensations come and go, come and go.

Tolerating the distress of a mammogram

Borrowing from Dialectical Behavior Therapy (DBT) tradition, when you cannot change difficult circumstances, it’s about getting through it without making things worse. After all, you wouldn’t want to have to reschedule your mammogram or have additional images taken because you couldn’t hold still. Within DBT there’s a set of skills designed specifically to help you tolerate your distress and survive the moment.

Here are some additional ways to get through a mammogram:

• Think of a comforting, safe image - some mammo technicians suggests your kids, grandkids or pets. Others mention butterflies and unicorns. Whatever floats your boat.
• Conjure up soothing sounds and play them in your head
• Say a prayer to your Higher Power
• Count to 10 and back – if this is too easy, count by 3’s. That should grab your attention
• Focus on touch – as you hug the machine, notice the texture, color, shape, etc.
• Notice what you hear – be curious and name the different sounds you hear. Can you notice a new sound every time the machine moves?
• Remind yourself this will soon be over - “Beth, you’re doing it. You’re here and this will pass.”
• Be grateful for medical access - “Beth, this hurts like heck but I’m glad you can access this kind of care.”
• Affirm yourself – “Beth, you’ve been through harder things and I’m with you and I love you.”

If the latter sounds a lot like self-compassion, that’s where we’re heading.

Extending compassion to yourself

Kristin Neff is a guru when it comes to all things self-compassion. Unlike mindfulness where you enter into the experience of pain without escaping, self-compassion is about seeing yourself in pain and wishing it wasn’t so. While compassion does not make the pain go away, it does ask the questions, “What do I need right now? Can I give that to myself? What can I do to hold myself with more tenderness?”

Self-reassurance and self-advocacy

Would it reassure you to tell yourself you’re well loved and cared for? Would you want to close your eyes and focus inward? Would it soothe you to think about your partner? If the technician is turning the dial too tight, would you love yourself enough to say something about it? I ask that because I once had a patient tell me her breasts were bruised for two weeks after her mammogram. She said the technician made the slides too tight and she didn’t want to speak up. You’re important to speak up for. Would you do that for yourself?

Life after cancer

While you may no longer be in cancer survival mode, follow-up appointments and regular diagnostic images are and will be a part of your life. You don’t have to white knuckle through these tests “just to get them over with”! You also don’t have to wish your cancer experience away. Let me know if you can use some help staying present, tolerating distress and loving yourself as you are. I’m here!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about couples and cancer, she has found yoga to be a wonderful practice to nurture mindfulness, distress tolerance and self-compassion. She has grown pretty fond of her toes recently. She says hi to them every time she passes them by.  

Body Image after Breast Cancer – What is Visible to the World

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In my last blog post, I gave an overview on body image after breast surgery and radiation. I invited you to befriend your breasts and come to accept them as they are. This takes time. When you’ve reconciled this loss, breast prostheses, mastectomy bras or reconstruction is the icing on the cake, rather than the cake itself.

Now, while it is devastating to lose a boobie or two, it is something private and can be covered up. What about the body changes that scream, “Cancer!” to the rest of the world? Treatment will lead to body changes that are visible to all. How do you involuntarily give yourself away?

Hair on your head

A study done by Dove in Dec 2015 found that only 11% of women love their hair as is. The rest of us wish that it was less wavy, more fine, less grey, more thick or, just fill in the blank. You never come to appreciate your hair as much as you do, until it starts falling off in clumps. In the shower, as you’re brushing it, while you’re going about your life: you’re shedding everywhere.

Some women choose to shave their heads early on to avoid the pain and the clean up of such a visible loss. Others choose to keep every strand of their hair until chemo is over and then get the shave to ready for new hair growth. Often times, patients speak to how difficult it is to face hair loss: there is no hiding that you have cancer and you’re going through treatment. A scarf or a wig simply don’t do the job of your own hair.

Overtime, if you are able to adorn beautiful head scarves, find a wig (or two) that lets you be yourself or wear your bald cut with pride, kudos to you sister! Whatever you choose, women can look amazing without long, thick, and shiny Pantene hair! But, what about other facial hair you had taken for granted?

Hair on your face

Brows look better thick and lashes long and thick, so says society. Regardless of whether you’ve totally bought into that message, we can’t argue the fact that your brows do help to shape your face and your lashes emphasize your eyes. When you’re going through chemo, your brows will likely thin out and your lashes fall out. These small changes can make you look and feel more vulnerable.

Let’s take a step back from these aesthetic features. Did you know that brows and lashes have actual functions? Brows help keep sweat and moisture out of your eyes while lashes protect your eyes from debris. Sensitive to the touch, lashes will also trigger the eyes to shut when there’s a foreign object near the eye. In light of that, can you imagine coming to appreciate why we have these hairy facial features? And, the next time you look into the mirror, remind yourself that these features have a purpose before the definition of beauty find them lacking and needing “modifications”.

Weight gain

Aside from hair loss, the other most noticeable change to the body during breast cancer treatment is weight gain. Perhaps you used to be active and lived a busy life. You might not have been training for a triathlon (or maybe you have been), but your schedule was full. During chemo, you inevitably experience early menopause and a drop in metabolism. Feeling tired and nauseated, you become less physically active and your previous lifestyle seems miles away. Side effects of meds can also cause increase in appetite and weight gain.

What to do about visible body changes

What would be giving and nurturing to you? Would you enjoy going for a makeover? Donning ginormous earrings? Loving your beret turban? Going for a head massage? Whatever it is, I invite you to be gentle with yourself. Your body needs A LOT of comfort and care, not a focus to return to status quo. Just as treatment is for a period of time, so some of the side effects of treatment will also be.

There is no returning to what is normal; rather, it’s about establishing a new normal. While it’s wise to have less on your schedule, you might try to slowly phase in a physical activity or two while on hormone therapy. Start with short walks and lengthen them with time. Be around good company for accountability sake. Above all, listen to your body; it has a lot to tell you.

If you need help reconciling these changes during and post treatment, let me know!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not at work, she has found yoga to be a wonderful practice to nurture self-compassion. 

Body Image after Breast Cancer – Boobies Then & Now

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I've been doing a breast cancer series on the messy feelings of cancer and the fear of reoccurrence. Another common theme I see facing cancer patients is the feeling of being "disfigured or damaged" after breast cancer treatment. 

Society's narrow definition of femininity

Let’s be honest here, our society has a general opinion about what constitutes femininity: thick lush hair and curvy body. There’s also something about a wrinkle-free forehead, better shaped brows, longer and thicker eyelashes and the list goes on. Wait, I should mention the many push-up bras and what?! A padded underwear? I had to look that one up. Needless to say, isolate any one of your body’s features and there’s a product or service to sell you because what you got, ain’t good enough. And that was pre-cancer.

Your body pre-cancer

You might not have bought into all the lies about what makes a woman beautiful, but let’s face it, none of us are immune to it. Whether you were satisfied with your body pre-cancer, or you were struggling with your body image, cancer treatment will rock your world.

Breasts

Boobies. You’ve got two of them, like you do two eyes, ears, hands, feet. No matter their shapes and sizes, they are visible to you, day in, day out. You look at them and they are a pair, a two-some, partners. As a society, we are fascinated with them. We are told they look better full (with no account for the back and shoulder problems they cause), symmetrical, and lifted and firm, and soft and supple to the touch. Aside from the visual aspects, women who became mothers and nursed their babies spoke about providing to their child nutrition, protection from illness, and a connection that, without one or both boobs, might be hard to rig up.

Breast surgery and radiation

In comes lumpectomy, single or double mastectomy and you lose fullness, symmetry and the ability to nurse on one or both sides. Radiation destroys breast tissue and often makes your breast more firm or “rubbery” in the long-run. Radiation also damages the milk ducts; stories of women who were able to breastfeed on that side are anecdotal. Whatever your boobs have meant to you, it’s time for a re-definition.

Breasts re-defined

Your boobies are yours. You’ve had them and you grew up together. You were on the monkey bars, went on field trips, pulled all-nighters, traveled, and shared them with someone you love. They might not have turned out the way you hope they would, but they were loyal to you and stuck by you through thick and thin. Now, they’re sick. Your good friends have fallen ill. Cancer cells are growing inside of them and in order to save your life, you have to bid goodbye to one, both or subject one to radiation. It’s hard to see them go or suffer. It’s like you’ve taken them for granted all this time. You don’t remember the last time you’ve given them close attention, complemented them or told them you love them just the way they are.

Post treatment and your boob(s) might no longer be there. If there, it has changed form and you’ve seen it suffer through the burn and rash of radiation. Whatever the state of your boobies, the soul of your boobies are still there. That spirit of love and companionship is still there. It has never left. If anything, it has grown stronger. You and your boobies have braved a very courageous endeavor, together. And, like before, you will continue forward, together. Whether you decide to seek reconstruction or not, it doesn’t change the fact that the spirit of your boobies live on. While your baby might have limited experience with nursing, you will bond with your child and they can learn all about your boobies, from you.

Compassion for your body

I don’t mean to be weird here; I’m speaking about self-compassion. Pre-cancer, people are often living busy lives, lugging their bodies around, subjecting them to caffeine overload, dehydration, stressful days and little sleep. We take our body's functions for granted, until something happens to them, then we give them attention. What if we take better care of our bodies and show more appreciation for our body’s features? What if we take the time to accept them rather than spend so much time covering them up, changing them, and rejecting them? What if we care for them, now?

Going forward

Just when I thought I could write one post on body image, I talked all about boobies. I will have to write a sequel on having a healthy relationship with the rest of your body post cancer treatment. In the meantime, if you are a breast cancer thriver and you need help extending compassion to yourself and caring for you, let me know!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not at work, she has found yoga to be a wonderful practice to nurture self-compassion.