Download 2/9/2015 1 A Woman`s Greatest Fear I have Breast Cancer!

2/9/2015
Interviews with real patients
A new case of breast cancer will be diagnosed every 2 minutes and a woman will die every 13 minutes.
Advanced Health Education Center
A Woman’s Greatest Fear
I have Breast Cancer!
The day a woman finds out that she has Breast Cancer is the beginning of a new and frightening journey. Many are in the prime of their lives and find themselves feeling blindsided by those two words‐even betrayed by their own body.
S. Eva Singletary,M.D. from “Moving Beyond Breast Cancer.”
First she must make life‐altering decisions at each
fork in the road. This is over‐shadowed by an intense
realization of her own mortality.
Women react in different ways and some will get breast cancer again
Radiation
Chemotherapy
Lumpectomy
Total Simple Mastectomy
Modified Radical Mastectomy
Radical Mastectomy
S. Eva Singletary, M.D. from “Moving Beyond Breast Cancer.”
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Figuring out how to get there, how to pick up the pieces
of their life and put them together again in new ways can be difficult.
Five Stages of Grief
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Denial
Anger
Bargaining
Depression
Acceptance
(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler‐Ross, 1969. Interpretation by Alan Chapman 2006‐2009)
Five Stages of Grief
1st stage ‐‐ Denial
Denial‐a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. (Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969.
Interpretation by Alan Chapman 2006-2009.)
Five Stages of Grief
2nd Stage ‐ ‐ Anger
• Anger manifests in different ways.
• angry with themselves, and/or with others, especially those close to them • Truth‐anger has no limits
• extends not only to your friends, the doctors, and family
• may ask, “Where is God in this?”
“ A woman’s tear” • In this stage, the world becomes meaningless and overwhelming.
• Life makes no sense
• in a state of shock and denial
• go numb • how to go on, can I go on, or why should I go on. • try to find a way to simply get through each day. • Denial and shock help her to cope and makes survival possible. It is nature’s way of letting in only as much as we can handle.
Five Stages of Grief
3rd Stage – Bargaining
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Bargaining‐typically facing death can involve attempting to bargain with whatever God the person believes in. May become lost in a maze of “If only…” or “What if…” statements Want life returned to what is was Want to go back in time: find the tumor sooner, recognize the illness more quickly, if only, if only, if only….
Guilt is often bargaining’s companion 2
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Five Stages of Grief
Five Stages of Grief
4th Stage ‐ ‐ Depression
5th Stage ‐ ‐ Acceptance
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Move into the present
Empty feelings and grief enters on a deeper level than can we can ever imagine
An appropriate response to a great loss or being diagnosed with cancer
Sort of acceptance with emotional attachment Natural to feel sadness, regret, fear, uncertainty
Shows beginning to accept the reality
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Varies according to the person's situation
Often confused with the notion of being “all right” or “OK” with what has happened
Will never like this reality or make it OK, but eventually accept it
Learn to live with this “new norm” Must see that the past cannot be maintained intact
It has been forever changed
Must readjust
(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler‐Ross, 1969. Interpretation by Alan Chapman 2006‐2009)
Women come from all walks in life and share this life‐altering experience with a deadly disease. These women, like many others, faced the diagnosis of breast cancer in their own way. Taking away from the experience a new and changed outlook on life. Ranging from strength to acceptance to despair.
Denise ‐ 3 different primary cancers 1988 – Stage 2 Right ILC, IDC, & DCIS – age 35
2007 – Stage 1 Right mucinous & DCIS –age 55
2010 – Left DCIS & ADH ‐ age 58
Treatments: 1988 – Lumpectomy with chemo and radiation
2007 – Total mastectomy, endocrine therapy and Anastrozole.
Listening to the stories of how some of my patients handles “I Have Breast Cancer!”
2010 ‐ Lumpectomy with 6 weeks radiation.
S. Eva Singletary, M.D. from “Moving Beyond Breast Cancer.”
Reaction: “First thought “Thank God I had insurance!” I quickly thought about my kids and immediately felt like I had just had the wind knocked out of my lungs. I had a million questions and it seemed liked there were red lights everywhere. My kids made a poster that said, “YOU will survive. Do it in spite of the fear.” Dec 2007
“Second time, I just couldn’t believe that after 19 years I had another primary cancer in my breast. Of course I cried. I decided immediately to get a mastectomy to hopefully make sure I didn’t get it again.” “Third time, I was shocked and couldn’t believe what I was hearing. It was small and I was told I should have a good prognosis. I am a fighter and will continue the fight.”
No images available for 1988
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A
Mucinous & DCIS
R
2010
2007
S
LCC Mag
L LM Mag
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Patsy – Stage 3 ILC, T3, N1, Mo
ER/PR + and Her‐2 ‐.
Diagnosed March 2007 – age 46
Treatment: Pre‐surgery took ACOSOG Z1031 trial, Exemestane, and Anastrozole. Lumpectomy Mar 4, 2007 which showed 21/29 positive nodes. Had a mastectomy three weeks later. Post surgery took Taxol, then 12 cycles of Paclitaxel, 6 weeks radiation, and Arimidex. ER/PR + and Her‐2 ‐.
2005
2007
Reaction: “It was earth shattering, like a kick in the gut. I cried a lot and felt sorry for myself. Then I pulled myself up by the shoulders and said “I was going to do this.” Nothing could change me on the inside, I would still be me. My kids said they would help me get through it. I believe there is hope for tomorrow and this too shall pass. A friend mailed me a funny card every day to cheer me up which really helped me. I had the help of my family and friends and I do not believe I would be as strong today without their help. I believe you should live each day to the very fullest and try to laugh at least 15 minutes a day.”
2005
2007
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Penny ‐ Stage 2B triple negative IDC
Diagnosed March 2010 ‐ age 34
Note: Penny was working in a high stress, fast pace job and
found her left breast mass in December 2009 but was too busy to get it checked out until the end of February. The tumor was growing rapidly and at time of mammogram, it was 1.8 cm. Four weeks later at time of surgery the mass was 2.5 cm. She had a total of 5 tumors totaling over10 cm in her left breast within just 6 weeks.
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Treatment: Had a double mastectomy, then 6 rounds of dose dense chemo (Cytoxin, Adriamycin, Taxol) every 2 weeks apart instead of every 3 weeks.
Reaction: “It was like being elected into a club you never wanted to be a part of or just a small piece of a much bigger puzzle. It stills your femininity (bald, no breasts, weight gain and puts you into menopause). It made me slow down, de‐stress my life and I spent more time with my kids. I feel like I got a gift – a totally new perspective on a life that you never would have had otherwise. Life is too short to worry about the small stuff. Live each day as if it is your last.” March 2010
LCC MagL
Lt LM Mag
Renee – Stage 4 Metastatic Breast cancer
Diagnosed April 27, 2007 – age 28
NOTE: Patient went to see her doctor for a lump in her breast and for severe lower back pain. Her doctor said she was too young for breast cancer and did not order a mammogram. He sent her to a chiropractor for treatment and pain medications. She took treatments for 6 months, wasn’t getting better so she decided to get a second opinion. Renee – Stage 4 Metastatic Breast cancer
Diagnosed April 27, 2007 – age 28
By then the cancer had spread to her bones and was told she would be lucky to live through the year. Then it was hard to see people continuing their normal lives – didn’t they realize I was dealing with breast cancer? 7
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Reaction: “I thought my world was closing in on me. I couldn’t believe it when the doctor said I had breast cancer. I cried. They started me on radiation to my lower spine which fried my female organs. I had always wanted children so this was like a slap in the face. But I also wanted to live and decided I would fight hard to save my life and would do whatever needed to be done. I have gone through a lot but there have been some victories. I kept my strength up and never lost the fight mentality. I say you have to bounce back, get up, dust yourself off and keep fighting the fight.”
Treatment: Started with radiation to her L5, S1, S2 vertebras through her abdomen which made her sterile. The cancer spread to her femurs and has a difficult time walking. Gets around in a wheelchair most of the time. Took Herceptin then dose dense chemo prior to surgery, had a double mastectomy, more chemo and finally radiation. Jun 2007
Apr 2007
First round of chemo was not working and changed her to dose dense chemo Bonnie – Stage 3 Metastatic Inflammatory cancer
Diagnosed September 11, 2008 ‐‐ age 48
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Renee lived for 2 years 6 months after her breast cancer diagnosis Treatment: Ultrasound, biopsy, pre‐
surgery chemo (herceptin),then a mastectomy with more chemo after.
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Reaction: “I got in my car, drove to a quiet place and cried for an hour.
Then I called my sister and cried some more. I took a recorder with me to every doctor’s appointment and then would go home and listen to it at least five times. It seems that breast cancer was a war I plan to fight. Once my treatment plan started, things started to happen like a whirl wind. No one can guarantee you can be cured but I was going to fight to win. I have always been so independent but you find yourself needing help and depend on others who also share your life. My son, John and his friends shaved their heads and put in my initials. I keep fighting everyday and don’t plan on giving up. Somehow you find the strength to keep going.”
Debbie ‐ Stage 2 Invasive Ductal and DCIS
Diagnosed ‐ July 17, 2011
‐‐ age 54
Reaction: “I was in complete shock and immediately went home from work and couldn’t stop crying. My friends came to comfort me. It was like a defining moment. You think the worst. You start seeing the doctors, ask them to repeat what they are saying but it just seemed like I couldn’t understand a single thing they said. I took a friend with me to every visit so she could explain what they were saying. “
Treatment: Biopsy of several nodes, Lumpectomy, chemotherapy (Taxol and FAC), and 6 weeks of radiation.
“It was very overwhelming with so many decisions to make and not sure what to do. I just knew I wanted the cancer out! I was very depressed when I heard that the chemo would make me lose my hair. I had some complications ‐‐ broke my right wrist, had to delay chemo for six weeks then problems with blood clots in my right arm after my first port‐
a‐cath. I got severe edema, swelling and pain that made my right arm feel like it was going to burst open at any moment.”
“I cried some almost every day wondering if things were ever going to go back to normal. Now I realize that I have a “new normal” and things are beginning to look up.”
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Year? CC
Year ?? Contact lateral
Year? Axillary laterals
1992 CC
1992 Contact laterals
1992 Axillary lateral
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1995 CC
1995 MLO
1999 CC
1999 MLO
2002 CC
2002 MLO
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2003 CC
2003 MLO
2007 CC
August 2005
2007 MLO
2009 CC
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2009 CAD
2009 MLO
July 2011 CC
July 2011 MLO
July 2011
July 2011
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Due to the significant improvements in early detection
and treatment in the last 30 years, most women diagnosed
with breast cancer will find themselves on the second phase of the journey:
The transition from cancer patient to cancer survivor. This part of the journey requires a return, not exactly back to Normal, but what some patients call the “New Normal.”
S. Eva Singletary,M.D. from “Moving Beyond Breast Cancer.”
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There have been several famous ladies who got
Breast Cancer and this is a song written for them:
YouTube‐ Original song for Breast Cancer Awareness You'll Soar.mp4
Sheryl Crow
Entertainer
I am many things today: I am a musician, an environmental
activist, and a mother. I am one thing more – a breast cancer
Survivor. Like all women who receive that terrifying diagnosis,
my response was a mixture of disbelief, fear, and anger. I
was young! I was healthy! What had I done to deserve this?
But as I was confronted with the reality of being treated for breast cancer, I found that when you hit the bottom, you really start to learn about who you are and who you want
to be.
“Moving Beyond Breast Cancer”
Kylie Minogue
Entertainer
“The moment the doctor told me, I went silent. My mum and dad were with me. Then we all fell to pieces.” 'Anyone who’s been through cancer or any other disease with surgeries and treatments knows you have constant reminders that this is not how it used to be. I think my path is written,' she added.
'Even if part of you wants to say, "OK I get it, I’m used to this", another part of you takes a lot longer to catch up with it and get with the program. I reached my 5 years in 2010'
Jaclyn Smith
Actress, Business woman
I was in a state of panic. It was kind of surreal, and you don't really hear what they're saying. The lesson I learned that day ‐ don't go it alone. I said “take my breast off, take it off, take it off” but my husband who is a doctor showed me why I should only have a lumpectomy. I did chemo and it is in charge of your life. You get sick and you get tired but you just have to say, “this is a year of my life, and it's going to be a short year and a long life.”
By Elizabeth Cohen CNN
“My cancer scare changed my life. I’m grateful for every new, healthy day I have. It has helped me prioritize my life.”
Olivia Newton John
Entertainer
“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face.”
Eleanor Roosevelt
First Lady
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“This is another kind of competition, but I’m being coached by an excellent team, and I’ve got a real strong competitive spirit.”
Peggy Fleming
Olympics Figure Skater
Handling the Diagnosis
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Journaling
Talking it out
Staying physically active
Dancing
Massage
Yoga
Art Advocacy Awareness
Journaling
Stacey‐35 yo special effects costumer diagnosed with ILC Stage II wanted a way to keep in touch with friends and family and let them know about her treatment. She credits her cancer with as a means of opening herself up through her writing and expressing herself her new life after a cancer diagnosis.
“ I think I opened up about myself and got more personal much quicker than I probably otherwise would”
“I mean I have to talk about my boobs so some boundaries were dropped immediately”.
Talking it Out
• 5 ½ weeks radiation therapy • 9 sessions of chemotherapy
• Double mastectomy..
She said she spent most of her time housebound feeling weak and anxious. Many of her friends did not call ore visit after learning of her diagnosis. She would blog with bloggers that had cancer themselves sending her notes and care packages.
“People were really wonderful. When you have cancer, some days you feel like you are the only person going through it, but blogging helped me get over those feelings of isolation”.
69 yo ‐inflammatory breast cancer diagnosis 1998
“You are desperate to talk to someone who has been through this, who can tell you what the next step is going to be”.
She did not have anyone to talk to while she was going through treatments
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Now she is a peer counselor for women diagnosed with breast cancer called Y‐Me.
“Talking to women who are at the very beginning keeps alive the memory. They want to know what is going to happen. We tell them what happened to us. Once we were just as stunned and frightened as they are now.”
“Very often, they will tell me at the end of the call that is has been wonderful talking to me.” “That I have helped. That makes it all worthwhile. But I think the calls do just as much for me reminding me how fortunate I am.”
Staying Physically Active
• 32 yo –Paget's disease 1996
No lymph node involvement
Double mastectomy
No chemo or radiation
Trained for NYC marathon
“It gave me a focus outside of myself.” “ I had a bigger thing to think about…it made me feel better about myself.”
“You feel like your body let you down at first.” “Exercise gives you faith back in your body.”
Dancing
Massage and Yoga
46 yo‐IDC/ILC‐1998
Attended a “Healing Dance” class offered by a Middle Eastern dancer
“The dance preoccupied me for several years afterward, as I renewed my comfort with myself and the changes brought by the mastectomy and the chemo treatments.”
“I took active pleasure in keeping myself fit., focused and confident through the dance.”
48 yo‐2004‐DCIS
Instead of worrying about her upcoming surgery (she had a massage before her diagnosis but not on a regular basis) decided to cast away her fears.
“I was focused on where I was at that point in time.”
“At that point, I was on a massage table. I knew I was in good hands.”
Yoga
Humor 26 yo‐IDC‐stage II‐2006
Mastectomy
“ I feel like doing yoga made a difference in my range of motion post‐surgery.”
“I almost push myself to get out of bed to do yoga.”
43 yo‐IDC‐stage I
BCS and chemotherapy
She resorted to something she always loved‐drawing comics. 2006‐comic book published
Cancer Made Me a Shallower Person
She writes about forgetfulness that comes from “chemo and radiation brain”. About the “Don’t look into the aperture” sign on the CT machine.
And about how Prozac has made things just a little bit better.
“That’s the way I think about life”. “ I love cartoons.”
Had a recent diagnosis of mets to the brain.
“I was rediagnosed while writing the book”. “I feel like it is kind of my legacy.”
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ART
38 yo‐DCIS‐1991
“I was scared out of my mind and had anxiety”.
“I needed a forum to express myself”.
She helped found Art.Rage.Us a traveling exhibit of art and writings created by women with breast cancer.
“It has helped me to say the unspeakable.”
1996‐diagnosed with mets‐Stage IV
“We all want to leave our mark on the world.”
“Not everyone will be famous or invent something important…When and if you die, you may not feel you have gotten things done. Creative expression will still be around.”
Advocacy
34 yo‐IDC Stage II‐2000
Bilateral mastectomy
She began attending conferences and lobbying politicians in Washington for more research on the disease. She became a three‐
time national breast cancer coalition team leader for their national lobby day.
“I found this voice and it made me feel I could have some control of his disease.”
“It gave me a real reason to keep on living.”
“I got to be part of a growing movement.”
“Activism and advocacy can be very powerful.” “You can feel empowered/\. Your voice does make a difference.”
Awareness
48 yo‐ILC BCS
She chose to participate in Mamorial.
This is a New‐Jersey based nonprofit group that takes molds of breasts used in all stages of the treatment process. They turn them into resin breasts that tour the country, raising awareness about breast cancer.
Some of them bear lumpectomy scars, others show the absence of breasts from mastectomy. The breasts come n all shapes and sizes with the color of the resin matching the skin color of the participant.
“It gives you a forum and a voice.” It let’s us say:
“Hey look at us…Look at what this is doing…awareness and education…now let’s get some research!”
In conclusion.
Stress does not have a positive side. The flight or fight response can help the patient rise to the challenge or provide the surge or energy needed to deal the threat. Chronic stress disrupts the body’s internal balance overworking its biological pathways.
A diagnosis of breast cancer is one of life’s ultimate stressors. The relationship between the mind and the body emphasizes the combination of both conventional and alternative approaches to address the biological, psychological, social and spiritual aspects of health and illness.
Dealing with chronic stress can elevate the chance of breast cancer in the first place and can affect mortality by placing constant demands on the body’s endocrine and immune systems. Depression is a chronic form of stress and makes the prognosis for cancer worse. Study's have shown that depressed cancer patients showed a significantly higher mortality than non‐depressed patients.
It is important for women to find an outlet, support and an avenue to take to deal with that knock on the door.
Knock..knock..you have breast cancer!
They must ……………………………
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YouTube‐ When Pink Is Just A Color Again ‐ Kal Hourd, for Breast Cancer Awareness ‐ Copy.mp4
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