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

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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

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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.

Should you Pass Gas in Yoga?

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I did it

I passed gas in yoga. Multiple times. Usually I'm able to hold it in. But, when I'm encouraged to twist into and hold my body in positions for an extended period of time, well, it becomes much harder to keep it in. Or, I'm just totally relaxed and uninhibited: I didn't even know I had gas until after the fact.

New Zealand study

So I went on to see whether there are any health detriments to keeping gas in. According to the New Zealand Medical Journal that looked especially at frequent flatulence while riding on planes, holding back can cause multiple health problems, including bloating, indigestion, heartburn, and in some cases, even pain. Wow, a habit of keeping it in isn't good for you, is it?

The essence of yoga

When I think about the practice of yoga, I think of staying in the moment and being present to whatever shows up. I'm reminded to be non-judgmental and to develop compassion for my mind, body and soul and whatever they might need in the moment. I'm encouraged to be in tune with my body and be curious about what it can do and would want to do, while stretching it to a place of discomfort, but never strain.

So which one is it? Do I "stretch" my body and keep gas in, all the while be stressed about it? Or do I compassionately release it in service to my body, though not so much to my neighbors?

Holding both

Now I don't mean holding gas, but rather, recognizing that it's both important to let your body feel the relief AND be kind to your yoga community. How do you do that? When you pass gas in yoga, remind yourself that it's a human condition and keeping moving. This may sound strange, but acknowledge that your body has that need and your body is naturally wanting to let it go because it's not good to hold it in.

And as a courtesy to your neighbors, stay away from beans, cruciferous vegetables, and the alike before class. One time I had homemade broccoli soup before yoga. Bad idea. I've also learned to eat a small meal and at least an hour before class. My body has taught me if it doesn't come out as gas, it'll find another way out.

Putting it all together

To pass gas is to be human. Doing so is letting your neighbors know that it is okay for them to also let it go. I remember one time when I heard a loud phhhhhhrt from across the yoga studio. It took everything in me to not approach the nice gentleman after class and say, “You farted? Me too!”

Other than gas, are there things you need help letting go? I'm here!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She loves helping people live compassionate and fulfilled lives. She enjoys yin, slow flow and power vinyasa yoga and her favorite pose is still Shavasana. 

Holding Orlando in my Body

Shortly after writing and beginning to process the two tragedies in Orlando, a 3rd happen. I cannot imagine what it's like to have been there, to be the family, to be witness to such loss, to hope that it wasn't the case, to wish it away every time I think about it.

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There is a tendency for me to enter into the experience of another and to carry this tension, this stress in my body. For days, I went around, trying to keep going, ignoring the signs that it's not possible. My neck and shoulders were sensitive to touch; I couldn't carry my usual backpack without having to put it down at every opportunity. My body was telling me I wasn't well. I didn't want to listen, until I could no longer ignore it.

I have a 4-day conference to attend and my backpack will be my constant companion. I finally made time for some mindful yoga, of slowing down to care for my body, to pay attention to it and let it know it is important. My body responded in kind.

I don't mean to undermine the magnitude of all that have happened in Orlando by talking about yoga as a solution. I do invite you to care for you, to listen to what you might need. Given all this, what would be helpful right now? What would still keep you close to the things and people that matter to you?

My body is crying writing this and it begs for another slowing down, another stretch. Just know that I'm here if you need anything.

Trying to Please Everyone? Kiss your Ass Goodbye

A Parable by Aesop

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An old man, a boy and a donkey were going to town. The boy rode on the donkey and the old man walked. As they went along they passed some people who remarked it was a shame the old man was walking and the boy was riding. The man and boy thought maybe the critics were right, so they changed positions.

Later, they passed some people that remarked: “What a shame, he makes that little boy walk.” They then decided they both would walk!

Soon they passed some more people who thought they were stupid to walk when they had a decent donkey to ride. So, they both rode the donkey.

Now they passed some people that shamed them by saying how awful to put such a load on a poor donkey. The boy and man said they were probably right, so they decided to carry the donkey. As they crossed the bridge, they lost their grip on the animal and he fell into the river and drowned.

The thing is, if you try to please everyone, you might as well… Kiss your ass goodbye.

Need help staying true to yourself? Give me a call!

Top Deathbed Regrets. Why Wait?

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Chronic Worrier, Anybody?

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No doubt, we all worry. What is that person going to think of me? Am I going to make this work deadline? What if it rains tomorrow and we need to take the party inside? When there's an actual threat of something going awry, worrying can be helpful because it motivates us into planning ahead and changing the things we can.

However, often times, worrying stems from a perception or a fear of things going wrong. It then becomes unhelpful when we're worrying for the sake of worrying, or when we think that worrying can somehow help us cope with life's problems. We get caught up in this endless loop.

Here are some ways to interrupt the cycle of chronic worrying:

1. Identify your triggers – what gets you worrying in the first place? Then what thoughts and feelings did you have next? If you don't recognize the cycle, you can't stop it.

2. Ask yourself, “Is there a problem to be solved?” – if you legitimately need to work a few extra hours to meet the deadline or come up with a plan B for the party, do it! If not, notice that your mind is playing the “worry tape” again.

3. Drop the struggle - “Don't worry, be happy!” If this had worked, we wouldn't have 40 million people in the US struggling with some form of anxiety. Intentionally trying to stop thinking about something only makes you think about it more. Try it now. Don't think about a white polar bear. What happens? You think about a white polar bear. It's not about fighting with your thoughts, but letting them come and go.

4. Notice your thoughts – is your mind feeding you worries that are “what if's,” unhelpful patterns that you can do little about? If so, acknowledge those thoughts again and again, but choose to not engage further. One way to do so, according to the tradition of Acceptance Commitment Therapy, is to say, “Thanks mind!” This may sound weird at first, but try it! You're re-training your mind and flexing that muscle differently, with time.

5. Stay in the present – worrying takes you into the future that has not yet happened and that likely won't happen the way you envision it. Thus, when you find your mind drifting to the worries of the unknown future, bring your mind back to the here and now, over and over again. Come back to this moment, the only moment you have to live in and can do something about.

6. Accept the unknown – you want things to happen a certain way: to arrive home accident-free, for the cake to not topple over, to win the project bid... Who doesn't? Yet, there are so many things you have little control over. Acknowledge that you are limited, still make plans, but hold them loosely. 

Here's an earlier post on what to do with runaway thoughts. 

Need more? Give me a call!