5 Tips for Managing Seasonal Affective Disorder

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'Tis the season to be sad

While I don’t wish this upon you, Seasonal Affective Disorder (SAD) is a thing around here. Especially with the end of daylight saving time, we’re feeling the effects of brighter mornings and less evening light. Given how much we love our Seattle summers, the shift into chilly, rainy weather, bare trees and gloomy skies is enough to make many of us want to crawl into bed and stay there.

If you are already struggling with depression, you might feel the effects of it more. If your mood is often weather-dependent or you’re a transplant from a sunnier climate, chances are it’ll affect you too. While winter solstice is less than seven weeks away, let’s help you figure out how to get through this long stretch of fall and winter months.

Before we talk about what to do, let’s address the symptoms of Seasonal Affective Disorder (SAD).

SAD defined

SAD mirrors symptoms of Major Depressive Disorder, also commonly known as Depression. You might have SAD if you:

• feel depressed
• don’t want to do the things you used to enjoy
• have low energy
• have trouble sleeping, often times oversleeping
• experience changes in your appetite, often times crave unhealthy comfort foods and experience subsequent weight gain
• feel agitated or sluggish
• have difficulty concentrating
• feel hopeless, worthless or guilty
• have frequent thoughts of death or suicide

If you have thoughts of wanting to hurt or kill yourself, you need to stop reading this and call the National Suicide Prevention Hotline at (800) 273­-TALK (8255). If you have a milder form of SAD but you’re feeling down, struggling to get out of bed, overeating, gaining weight and saying no to social engagements, then here are some recommendations for you.

5 ways to move through SAD

1. Light therapy

You know that it’s a common purchase when they sell it at Costco. Therapy lamps provide bright, artificial white light during months of diminished sunshine. Keep it in a well-trafficked area and follow instructions for use between 20-60 min. Depending on your circadian rhythm, you might find the light exposure helpful in the morning or the evening. Remember to choose a light box that emits 10,000 lux, which is equivalent to 20x that of usual indoor lighting. With lesser lux units, you might need to use the lamp for longer to get the same effect.

2. Physical activities

I don’t mean exercise. The gym is not for everybody. Rather, there are a lot of fall and winter activities that can get your heart pumping and your brain releasing happy hormones. It can be indoor climbing, yoga, laps in the pool, racquet ball, even housework. Outdoors you have a walk around your office or neighborhood, winter hikes, and snow sports.

Now I understand the fact that you feel SAD means you don’t want to move very much. However, if you wait until you want to do something before you do it, you might never do it! Instead, act the way you want to feel. That said…

3. Positive activities

What activities used to bring you alive? What did you use to enjoy? Or, what is something new you’d like to try? It can be a physical activity listed above or it can be art walks, concerts, a meetup, a good novel, a weekend away. You can be with strangers, close friends or be by yourself. Given the tendency to socially withdraw, I’d recommend doing some activities with others and developing accountability to increase follow-throughs. While there’s no guarantee that you’d feel better afterwards, it’d help you in the long run to stay active and engaged in life.

4. Medication

I don’t know how you feel about taking meds, but sometimes an anti-depressant is necessary to get you past this hump. It doesn’t mean you have to stay on this medication forever; only until you have more tools under your belt to be without it. Also, if you’re currently on an anti-depressant and you’re questioning whether it’s working properly, it’s probably time to visit your prescriber again. Remember that it can take up to 6-8 weeks for the medication’s benefits to kick in, while you might feel the side effects more immediately.

5. Take it in

While this is not the most exciting time of the year for you, can there be any beauty in taking in the vibrant colors of the leaves, the rustling of leaves against the wind, or the crunching of leaves under your feet? What about the beating of rain on pavement, the dancing flame from a crackling fireplace, and the warmth of peppermint tea against your lips?

This will pass

This season is here and it will pass. Since there’s no ushering it away, I hope there’s a part of you that can find it a friend, rather than a foe.

And if you need a therapist to help you ride out this season, 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. This fall, she noticed the changing colors of the leaves more. Her favorite food group this season is all things squash and her favorite activity is baking.

How to Overcome Barriers by Cultivating 1:1 Relationships

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My new pet peeve

So I go to yoga about two times a week, preferably three. I love the studio; love the teachers. It’s a great community there. It’s like 83 degrees inside and people sweat bullets, or more like puddles. I’m fine with feeling my own sweat and wiping it but I discovered a new pet peeve: I don’t like stepping on other people’s sweat. There’s something about my bare feet touching someone else’s bodily fluids that makes me cringe. The mood lighting does not help as I navigate my way around the studio after class. 

How I’ve coped

As with most pet peeves, we find a way to cope with them or to otherwise avoid them. I’d scoot around the studio after class, using what little lighting there is to side-step shiny liquid reflections. If I’ve landed on a puddle, my towel is just a reach away. This was my coping strategy, until one day, my world was turned around. 

Sweat has a name

It was a usual Wednesday evening class with teacher Aaron and he asked us to do something out of the ordinary. After some power vinyasa routine where we were dripping wet, he asked us to find a partner to do this strap exercise. It looks difficult enough: you’re doing some backbend with your leg behind you strapped to your hands overhead. Your partner is spotting you. “Bob” and I were the only ones without partners and I jumped to my feet to join him.

We met in the middle of a matless area and started doing the pose with me spotting him. He talked about not being very flexible and fell over. Fa-thud! I’m not a very good spotter, am I?! Someone then recommended that we do it on a mat and we walked over to his mat. He had a towel spread over it and it was soaking wet. “Bob” was noticeably embarrassed. He started wiping the outskirts of the mat where his sweat puddles formed. He might have apologized for how damp his towel was, but I don’t remember.

None of that mattered. I was about to spot him again so he could do his backbend, hopefully without falling. And I had a few turns and realized the pose was easier than it looked. We chit chatted for a bit while waiting for Aaron to gather us in. We shook hands, shared our names and I eventually went back to my mat. 

Why wasn’t I bothered?

My feet were damp and I wiped them off but I didn’t feel the usual disgust. Why? It could be that I was distracted by the pose or engaged with “Bob.” In retrospect, I think it had more to do with the fact that sweat has a name and it belonged to “Bob” and he was kind and personable. “Bob’s sweat” didn’t bother me because “Bob” is a human being I have come to know, for all of ten-minutes. It’s no longer a nameless sweaty pile on the floor that I tip toe around. 

Perhaps it is a bit of a stretch to say that “Bob” and I have formed a friendship, but he sure is no stranger. He wasn’t in class this past week; otherwise I would’ve waved. The human-to-human connection changed the way I feel about something I used to dread. While I can’t say I’m now free to glide through the yoga studio in the dark without holding back, I am a step closer to that direction because of “Bob”. 

So why am I telling you this story? 

Relationships break barriers

When I think about my experience, that human touch made a difference for me. It’s after all easier to stay on our “mats” or “pair up” with people we already know and feel comfortable with. But we then miss out on opportunities to get to know an “other,” someone different than you; someone different than me. When we do take that time, what might happen? What beliefs might be challenged? What relationship might come of that? 

At the core of who we are, we’re human beings who breathe, sleep, eat, pee, poop and yes, sweat. We all feel glad, sad, mad, fear, disgust, shame/guilt, surprise, and interest. We are all a brother, a sister, a daughter, a son, a friend to someone, somewhere. Our humanity is our common denominator. And, we can be each other’s guide through the discomforts of life if we allow each other in. 

If you ever need help leaving your “mat,” you know where to find me. 

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She mostly helps unhappy couples and breast cancer patients. At the heart of what she does, she’s about helping people flourish and live compassionate and vital lives. She can be found at PeopleBloomCounseling.com.

Two Approaches to Dealing with your Fears

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I was born a little skittish. I get startled easily when I see and hear something I don’t expect. I had to tell my husband early on in our marriage to make noises as he enters the room. Otherwise, I’d scream bloody murder, which would freak him out. Oh, and I don’t like scary movies. Husband got into a kick recently and watched the three original Alien movies while I was out-of-town. Good, cuz it ain’t happening when I’m home.

The thing is, we’re all wired a certain way, along the continuum of higher versus lower threshold for fear. It’s not a right or wrong, good or bad. It just is. But, what’s the point of fear? Is it even necessary? Ever wondered where fear came from?

The origin of fear

Too many million years ago during the age of saber-tooth tigers, wonderful men hunted and awesome women gathered. Whether they were out in the fields or back at the shelter, they had to be on hyper alert for wildlife. They were either going to have lunch or be lunch. With that hard-wired alert for danger, those who were careful and watchful procreated and lived on. Those who had a low radar for fear and lived a carefree life did not.

What does this mean for us in 2017?

Real threats

Though we’re no longer living amongst saber-tooth tigers, some threats in our lives are very real. It could be a life threatening illness, an accident, any other traumatic events or threats to our dignity as people. During these moments, our fears make sense and fit the facts of the situation. These threats ought to make us have the automatic reactions of fight, flight or freeze. When our fears are justified, we should take action to effect change where we can. This is for our survival and the survival of people we care deeply about.

Perceived threats

There are real threats and then there are perceived threats. Perceived threats are when you’re no longer in the car accident, in the abusive relationship, in the situation that made you feel so threatened and yet, you live as though you’re still in that life-threatening event. Or, your fears are not tied to something that has happened, but a fear that something might happen. You then avoid places, people and activities that might remind you of your fears, examples being you do less because you fear failing or embarrassing yourself in public. When checking the facts of the situation, you realize the probability of something bad happening is very low, or your fears may be unpleasant, but they’re not life-threatening. What are you to do?

Facing perceived threats one of two ways

When your fears are not justified, it is important that you learn to face your fears. I share two approaches here:

1. Whatever you’re afraid of doing, do it over and over again.* Not kidding you. When there is little evidence for why you should be afraid of something that has occurred in the past or might occur in the future, the way to overcome that fear is to face it head on. Do the very things you want to avoid with consistency. Is it public speaking? Getting behind the steering wheel? Watching certain shows that might be triggering? Take baby steps to overcome your fears by approaching, rather than withdrawing. Overtime, you’ll feel more in control over your fears.
2. Harry Potter shows us another way to face our fears during a boggart lesson:

We can have a different relationship with our fears.** Put in its original context, Ron’s afraid of spiders, Harry Dementors, and Professor Lupin a full moon. When they cast the spell Riddikulus and envision something humorous, the shape-shifting boggart assumes a comical form. Followed by outright laughter, they had the power to make the boggart disappear!

While we don’t have this power at our disposal during current times, Professor Lupin’s lesson is for all of us. Can we see our fears differently, and therefore, relate with them differently? What if a natural disaster turned into a ribbon twirling performance, social humiliation took the form of people high fiving you, and the car accident transformed into a scene from Fantasia?

Facing your fears together

Don’t let the fears of your fears hold you back! If you need help facing your fears or otherwise make them ridiculous, well, you know where to find me.

* Borrowed from Cognitive Behavioral Therapy and Dialectical Behavior Therapy
** Borrowed from Acceptance Commitment Therapy

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She mostly helps unhappy couples and breast cancer patients. She also loves helping people address fears that hold them back in life. Her favorite Harry Potter films are the Order of the Phoenix and the Deathly Hallows: Part 2. Her worse fears are, well, she can identify with Ron. 

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. 

Living with the Fear of Cancer Recurrence

stephm2506/stock.adobe.com

In my last post, I talked about the complex feelings of cancer diagnosis and treatment. I wanted a separate post to specifically target the fear around cancer recurrence.

Whether you’re still going through cancer treatment or it has been years since you were treated, the fear of cancer coming back is very real. You’re attuned to every ache and pain in your body and instead of thinking that these discomforts stem from sore muscles or the beginning of a cold, you think cancer. Perhaps you secure message your doctor’s office for reassurance or you talk yourself down from feeling anxious. Nonetheless, the thought of cancer is ever looming.

Anxiety about cancer recurrence is normal

While most cancer patients who initially reported depression at the time of diagnosis experienced little to no depressive symptoms 10-years post treatment, the anxiety stemming from cancer is still there. After all, to have a cancer history is to face realities that cannot be fully changed or influenced. Sure, you might decide to eat healthier, stay physically active, manage stress better and maintain supportive relationships around you. While these are all good lifestyle habits to have and nurture, nothing you do can guarantee a cancer-free future.

What to do with healthy anxiety

First of all, if you feel something unusual during a breast exam (and the best time to do a breast exam is at day seven of your menstrual cycle), please do contact your oncology clinic. Similarly, if your body is exhibiting symptoms you don’t recognize or common symptoms are lingering, it is wise to seek medical advice. It is important to listen to your body and care for it; otherwise to ignore these symptoms is to deny that something is wrong. Burying your head in the sand only increases the likelihood of you getting your ass kicked.

What is constant anxiety

There is a difference between caring for your body and smothering it. You know your anxiety is in the driver’s seat when you’re constantly thinking about cancer, Googling every body discomfort known to man, and seeing your providers above and beyond normal follow-up appointments. You might be very rigid about the lifestyle choices you make. For example, you can’t miss a day at the gym, there is little to no flexibility in your dietary choices (unrelated to allergies), or you get easily agitated when you perceive that others are critical of how you’re managing your cancer. In other words, your world evolves around your cancer.

What to do with constant anxiety

Your body responds with anxiety when there’s a perceived threat. After all, cancer was and still is a huge threat to your existence. Doesn’t it make sense that you be constantly watchful of it? Knowing that, it’s important to realize that fear is your friend, not your foe. It is there to protect you; to preserve you. The key here is to befriend your body and to acknowledge your fear while putting it in the passenger seat.

Anxiety management techniques

What to do with your thoughts

Just because you think something does not mean it’s happening or that it’s true. Try it: think of a pot of gold. Think super, uber hard. What happened? Did you get rich from conjuring up images of gold? If you did, please come to my office and have those same thoughts. Okay, so you know I’m being facetious here. What I mean is that when your mind thinks something, that’s all it’s doing: a string of words came and went. You can entertain these words and attach a lot of meaning to them, or you can let them come and let them go.

Put simply, thoughts are either helpful or unhelpful. Helpful thoughts can be, "How do I make the most of what I have?" or "These things are meaningful to me and I'm going to do them!" When these thoughts come, listen to them and act accordingly. These thoughts are serving you. 

On the other hand, with thoughts like, "I can't enjoy my life because of my cancer!" or "Cancer is just going to come back; I know it!" acknowledge them and let them go. Like the pot of gold, just because you think it does not mean anything. In learning to have a different relationship with your thoughts, you’re essentially saying, “I hear you thoughts and I won’t be minding you so much. Here, why don’t you sit in the back? I’m still the one driving.”

What to do with your feelings

Similarly, when feelings of anxiety come, let them be there. Don’t push them away; they will only come back stronger. Acknowledge them; sit with them; talk to someone about them. While these feelings are scary, you can make space for them. What do they feel like? Does your heart pound? Do you get sweaty palms? Is your stomach churning? Know that these sensations will pass. As you ride through the waves of these feelings and body sensations, you can still be in the driver's seat, making the most out of life. 

Staying present

The fear of cancer recurrence has you looking into the future. It is thus hard to focus on the present and what’s going on right now. What have you been missing out on? Is it the changing colors of the leaves? Conversations with your loved ones where you’re only half listening? Finished a meal and you don't remember what you ate? When you find your mind focused repeatedly on your worries, acknowledge your mind, and come back to the present moment. Right now is the only moment you can do something about. Don’t miss out.

Need more?

Often times it helps to have someone come alongside you as you learn how to put cancer in the passenger seat. At the very least, because you’ll still have follow-up diagnostic tests and exams, you know the thoughts of cancer recurring are not going away. However, it doesn’t have to dictate your life. Let me know how I can help!

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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 could 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 work, she loves spending time with her hubby, eating good food and more recently, watching Harry Potter. 

Staying Focused

Dayne Topkin/unsplash.com

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She loves to help people find the path towards their own journeys. A little lost? Give her a call! (Please note she's directionally challenged in real life and this call for help only applies to therapy.)

How Standup Paddle Boarding Informs my Life and Counseling Practice

I'm out and about, living my life and I see stories that tie into how I practice counseling. Here is an example of such.

SUP

I first tried SUP in O'ahu. I took a lesson with my husband, mother-in-law, and brother-in-law and we were in very calm waters inside a canal. I was the only one who didn't fall in. I used to be proud of that, except when I look back, I knew it was because I was the only non-swimmer and was tensed the whole time. I really didn't enjoy the lesson as much as everyone else. They were laughing and splashing around and I was, just scared.

Is it possible that falling into the water is a part of the SUP experience?

SUP + falling

Now a few years later, I've grown less afraid of water and have been out on many more SUP adventures. I've decided that falling in is inevitable: a friend can threaten to tackle me, I can collide into my husband, the currents might be too strong... When I fall in, it is an opportunity for me to work on my chicken, airplane, solider stroke. And while there really isn't a graceful way to fall, it is still preferred to fall directly into the water rather than to hit the board first.

SUP + waves

It's not always calm like the canal. Boats and jet skis pass by, it's breezy, or the water is just choppy. I've learned that if we waited until it's calm, we might never head out.

It's tempting to sit down when the waves come. Sometimes I sit too long before I get back up. And I've tried avoiding the waves, only to have them catch up with me. It seems counter-intuitive, but the most effective way to go through the waves is to face them head on. When I point the nose of my board perpendicular to the waves, while I still feel the motion, I'm actually more stable.

Now I'm not saying there isn't a time and a place to sit and ride out the waves, or even take a break ashore. My husband and I were in Maui and the white caps barely missed us. It wasn't wise to stay out, especially not with a sea-sick husband. But, it's important that that experience did not keep us in the rest of our trip.

SUP + joy

So, what's all the rave about SUP? Why bother? SUP takes us places we couldn't otherwise go. Today, we started out at Madison Park and explored the Arboretum. It was a gorgeous day in Seattle. We got to watch the clouds change patterns, feel the warmth of the sun on our backs, say hello to kayakers and canoers, and explore beneath the 520-bridge. The waters gave a beautiful reflection of the sky and the motion of swaying side-to-side soothed and comforted us.

SUP + life

What parallels am I drawing here? There are times when life is calm. Enjoy those moments. And when it gets rough, know that's also a part of being alive. Falling is inevitable, and getting back up can take a while. After getting back up, it's tempting to stay put so you don't fall again. But when you're sitting down, it's also hard to go very far.

What if feeling the currents of life and feeling off balance at times is a part of living? There's no way around that. And when you try to run away from problems you need to face, they will catch up with you. Like in my previous blog post quoting Robert Frost, it helps to keep going.

That begs the questions, “Where are you heading? What do you want life to be about? Have you let the current of life swept you in another direction? Or, are you distracted by where others are going? Can you pause to orient yourself to where you want to go and keep heading in that direction, even though you can't see very far?”

Focus on what's near you. You can make immediate choices and overcome challenges that will get you closer to where you want to go. Then, remember to zoom out and look ahead. Don't lose sight of where you're heading. You can always change direction based on what you value and the goals you set.

Sure, have your me-time, but know that life is not meant to be journeyed alone. It helps to have someone share with you the joys and the trials. This could be a partner, and it could also be family and friends. In a recent blog post, I talked about why relationships are important.

SUP + psychotherapy

What about my counseling practice? How does this apply? I believe you want your life to matter for something. I want to help you get there, one moment at a time. Try swiping your paddle in the water this way, what happens? If you went back to the gym only 1x/week, what would happen? What if you reached lower with your paddle, how does that affect your speed? If you were to practice this defusion exercise I give you, would you let me know how that worked for you?

Ultimately, you don't HAVE to do anything I ask you to do. After all, I want your life to be about wanting to, rather than having to. However, I'm guessing you want your life to be different, and I would want that for you too. Would you join me in braving the waves, the falling in, while learning ways to face your problems as you live a value-driven life? I'm ready when you are.

Note: while I love being on a SUP, I want to clarify that I don't practice psychotherapy on one. 

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She has a vision to help people flourish and live vital lives. One thing she loves about SUP is the little waves she creates when she goes perpendicular to the current. It makes her feel like she's chartering a small boat.