Survivors / Healthy Living You've
had breast cancer, you've been treated for it, and now it's time to get
on with your life. But your life has changed, and you have to adjust to
your new situation on a number of levels.
Survivorship means being followed for the rest of your life. At a
minimum, the follow-up involves regular monitoring for a recurrence.
This should include routine discussion of whatever symptoms you might
have or problems resulting from the treatments you have had, a
physical, and a yearly mammogram. If you are taking tamoxifen, you
should also have a yearly pelvic exam.
It also means being aware of chronic treatment-related side effects,
such as fatigue, sexual dysfunction, "chemo brain," and pain syndromes,
and monitoring for potential late effects of treatment, such as heart
disease, lymphedema, and second non-breast cancer malignancies.
While this might sound depressing, it shouldn't. It means that we now
have enough experience with survivorship to know what to look for and
what to do about it.
Tips for Staying Healthy Have regular follow-up exams.
You should schedule regular follow-up examinations with your surgeon
and other members of your medical team. These exams will assess how you
are healing, as well as to find any signs of recurrence or of problems
resulting from the therapy. If at any time you have a new symptom that
doesn't go away in a week or two, you should schedule an appointment to
have it checked out.
Get regular mammograms.
Your surgeon will probably want you to have mammograms every six months
for a year or two, and then once a year. In addition to monitoring the
treated breast, the doctor will examine your other breast yearly for
the possible development of a new cancer, since women with cancer in
one breast have an increased risk of getting it in the other. This is
particularly important if you have a BRCA1 or BRCA2 gene mutation. In
this situation, MRI may be done as well.
Maintain insurance policies.
Whatever you do, don't let your insurance coverage lapse. If you're
already employed, then you know your company cannot drop your policy.
However, many insurance companies won't sign on a new client with a
life-threatening illness. Some insurers will agree to a limited policy
that covers everything but claims related to your illness. If you are
in the midst of changing jobs and switching to the plan offered through
the new company, make certain your coverage will remain intact. And, if
you take a break from work, be sure to maintain insurance coverage on
your own. It may be more expensive, but you want coverage in case of a
recurrence.
Treat cellulitis quickly.
Cellulitis is an infection of the skin. It occurs more commonly in
places on the body that have diminished access to the immune system,
such as areas of swelling or areas that have been radiated. It can
start from any small infection and rapidly spread, often with a red
streak up the arm or redness of the arm and/or breast. There is usually
a fever as well. Although this type of infection can sometimes be
treated with oral antibiotics, more often than not it requires
hospitalization for intravenous drugs. Some women who are prone to
recurrent attacks of cellulitis find it useful to ask the doctor for a
prescription for an antibiotic to carry around with them so they can
start taking it if there is the least sign of impending infection.
Attend to your relationships.
It's important to realize that the cancer has affected your whole
family, not you alone. While you're in treatment you're usually focused
chiefly on yourself, because you have to be. But as soon as you can,
address how your condition affects those closest to you. Partners of
women with breast cancer also have feelings that need to be
acknowledged. Couples therapy can help. It's crucial to communicate
with each other at this time and to work through the complex feelings
you are facing. Being as open as you can be with your children is
important for you, and for them. Breast cancer has particularly complex
ramifications for a mother and her daughter. It may be worth
considering family therapy with your children or the whole family.
Nurture your sexuality.
One of the least discussed subjects about life after breast cancer is
sexuality, yet many women have difficulties with sex and intimacy
following a breast cancer diagnosis. Aside from feeling that their
bodies have betrayed them, they may feel as though they've been
violated by the treatments. Most women find sex hard to talk
about—especially when it concerns feelings, perhaps only half
recognized themselves, about losing both their sexual attractiveness
and their own libidos when they lose a part of their bodies so strongly
associated with sexuality. It takes a while to feel good and in control
of your body again. You need to communicate these feelings to your
partner so he or she can help you in your healing and so that together
you can explore new ways of lovemaking that you both enjoy.
Attend to your emotional healing.
Emotional healing techniques are more varied and individual than
physical ones, but there are many that have proved helpful to women
with breast cancer. Psychotherapy can be a tremendously important tool
at this time, as it is in any time of great emotional stress.
Persistent feelings of sadness, loss of self-esteem, and lack of
interest in things that brought you pleasure before your cancer are not
typical and should be followed up. Many women find it helpful to keep a
journal of their emotions and experiences. Writing can help you to sort
out your thoughts and feelings.
Consider a support group. You might want to join a support group,
especially if you were too overwhelmed to do it during treatment.
Sometimes one-on-one brief counseling can be tremendously beneficial,
particularly if you are finding it difficult to move on from the
aftermath of your illness. Other women prefer keeping a journal. And
still others decide to volunteer to assist other women going through
breast cancer or to work with advocacy organizations working to end breast cancer.
Live fully.
Finally, make sure you don't feel ashamed of what you've been through.
Cancer still carries a stigma in our culture, and breast cancer can
have especially difficult associations. Demystifying cancer is
important. So is learning the many positive things that you can take
from this experience. I often hear women say that while they would not
wish cancer on anyone, they find themselves living more fully, they
"don't sweat the small stuff," they cherish their families, and they
truly value each day.
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