SURVIVOURSHIP

Life after treatment

There are many reasons why being a bright young thing is awesome… maybe you have a bountiful sex life or an amazing career.  Maybe you’re in the middle of having a family or planning to start one.  Maybe you’re looking forward to buying a home of your own or meeting the partner of your dreams.  It’s a bit of a downer when along comes big bad Cancer to ruin you parade (or actually your lovely life as you know it).

Having breast cancer in your 20s, 30s and 40s sets you apart from the madding crowd as you’ll find hospital systems, health information and support resources well and truly biased towards post-menopausal women with breast cancer.

Survivorship concerns and life after treatment issues particular to us young things include:

Support Groups and Counselling
Fear of recurrence
Relationships with loved ones
Dating and intimacy
Fertility
Diet & Exercise
Finances & Career
Delayed Reconstruction

FERTILITY & FAMILY PLANNING

Whether you’ve yet to even start planning for children, or are in the midst of having your family when cancer shows up, you can bet your sweet life that possible chemo or hormone therapy induced menopause (or chemopause as it’s called!) wasn’t going to be a part of the equation.

With chemotherapy working to disrupt the growth of fast renewing cells (hair, nails, mucosal membranes and more importantly cancer) it also has an effect on the tissue of your ovaries.  Your periods usually stop during treatment and depending upon your age (and how close you are you natural menopause) you can enter premature menopause.  If and when your periods return, the ovarian terrain after the battle has ended may have suffered lasting damage to egg production and quality.  In all honesty you won’t know until you try and that’s why IVF treatment is often undertaken before chemo treatment to combat this risk.

You may also be on the receiving end of some hormonal tweaking if the cancer showed a fondness for using your own hormones estrogen and/or progesterone as fuel for growth.  Again, this can have implications for your family planning but periods usually resume approximately 3 months after stopping therapy.

Even if chemo or hormone therapy are not part of your treatment plan, the period while you are monitored for the possibility of recurrence will mean that your child-bearing days are going to be postponed for a while yet (at least until you have been cancer-free for a certain period of time after treatment ends).

Like any fertility issue, the whole deal can be frustrating, emotionally draining and damaging to relationships as you try to navigate this new terrain.  You will experience some degree of grief as you let go of how you had it planned and wait to see how things will now play out.  This can be excruciating when surrounded by breastfeeding and pregnant women and pregnancy announcements from those close to you coming fast and frequent at this time of your life.  Your face can start to hurt from the unwavering smile you have adopted to show that you are genuinely happy for those you love as sympathetic eyes dart in your direction.  It might not be that you even wanted to start a family right now or indeed ever – it’s more that uninvited cancer dictates the possibility and/or timing and we all know how much we hate being told what to do, especially when you didn’t ask for the input!

Its important to remember you are not your feelings (and there can be some pretty ugly ones) and to make use of whatever tools you have at your disposal to deal with how you feel.

BODY IMAGE

While most of us have imagined what we’d look like with a little nip/tuck here or there, its unlikely your thoughts pre-cancer included nipping a lump from your breast or tucking in where it had been removed completely.  With most treatment for breast cancer including surgery of some form its unlikely your body image will come away from this experience unscathed either.

Individual experience varies greatly, for some the liberation of a flat chest after living with large breasts is a welcome change whereas others find looking down to a constant reminder of what you’ve lost to be very traumatic.  Acceptance is the key to rebuilding your self-esteem and this takes time and patience.  You may be fine to look in the mirror or show others your new body but its also perfectly normal to not want to be seen topless or even look yourself.  Just do what feels right for you and ask for help if you feel it’s affecting your life or becoming a  problem.

Looking at photos of other women with mastectomies can break down some barriers and it can help to check out someone else’s scars in person and compare if you ever get the chance should it come up in conversation. A surprisingly common response to your new post-surgery body can be that it looks a whole lot better than the peculiar shark-attack scars you’d imagined.

While you eventually have to come to accept you’re never going to look the way you did before surgery – its comforting to know that a) the cancer has now gone and b) there are great options available to us young things to once again have something (other than socks) to fill your bra.

Oddly enough – the whole process of having breast cancer can give you a newfound respect for your body or an acceptance that you didn’t before have about your legs/feet/thighs/buttocks/ears/nose etc.  Yes it’s a shame it can take cancer to feel this way about yourself, but its much better now than never. The sickly saying was right all along… cancer really can be a gift (albeit akin to a novelty hand-knitted jersey or quilted toilet roll cosy – one you don’t need and would much rather not receive!).

FRISKY BUSINESS

Now there’s a few possible scenarios here…

 
Never been better!

Great stuff – you go girl!

 
Not like it used to be but getting there

Take it slowly, get to know your new body and enjoy rediscovering each other after all you’ve been through.  It’s one of the best ways to feel closer, less stressed, more connected and takes your mind off everything (for a little while anyway!).

Erm…what sex life?

Rest assured, its not uncommon after the shock of diagnosis, raft of gruelling treatments, early induced menopause, hormone tweaking and stress of the whole shebang, to find you a bit lacking in the frisky business department.  If you’re not really feeling it in the bedroom the first thing to do is just to go easy on yourself (and your partner)  – cause the last thing you’re flagging libido needs right now is a big dose of stress to really put out the fire.

One response to all the prodding and poking you’ve received can be to retreat into your shell and not even want to be affectionately cuddled, held or comforted.  It can feel sad and worrying if you find yourself cringing when your kids/partner/pet/well-meaning friend try to comfort you, only to find you’re rigidly responding and not remotely into the experience.  Rest assured, this is all a normal response to not having your body as your own and it gets easier with practice and time, but it can take some work.

Starting initimacy in little steps can really work – just holding hands, having a cuddle, giving a stroke or something small, can be the start of getting touch back into your life.  If you find yourself backing away from any contact with your partner whatsoever in case it leads to feeling pressured to have sex, you may find agreeing on a time period (say a month) without any sex, can allow you to practice expressing affection during that time without pressuring or guilting yourself.  As with most of this cancer business, talking things over with your partner (especially if you’re going to try the sex-free period!) will help you and them to understand what’s going on and how best to get back on track.

It’s a work in progress

If you’re a single lass when the C bomb lands – you’re faced with a totally different dilemma in the sex life department as you figure out how to play the dating game with an altered rule book.

Once your confidence is restored and you get back out on the scene you’ve got a couple of big considerations – like how to answer innocent questions such as, what you’ve been up to lately? (oh nothing really, just a few rounds of chemo, removal of some of my most feminine parts and a bit of radiation – how about you?). You’ve got to figure out when to mention the C word (if at all) and if things develop further then you’ll find yourself maybe having to explain that you hang your boob(s) on the door handle when you retire for the evening.

It’s a tricky one to handle, and you’ll maybe fail a few times before you work out your game plan, but don’t let it put you off meeting people altogether. In addition to any village idiots you may encounter there are also the lovely people, just like you, that will totally understand, and they’re the ones really worth getting to know.

RELATIONSHIPS

One thing is for certain, from the moment you get told you have cancer, everyone around you now has cancer in their lives.  Like you, they’ll experience that same fear, shock, disbelief and helplessness – with the exception that they’ll not only have to look after themselves, but also look after you to some extent.

 
Kids

In every way, cancer and kids don’t mix – gruelling treatment regimes, constant hospital appointments, toxic chemical cocktails and low energy don’t make for the most patient, fun-loving and understanding Mum.  When looking after yourself requires so much help at this time, looking after others can seem inconceivable.

But cancer or no cancer, nothing on earth like a mother’s love for your sticky fingered toddler, smiling and enthusiastic 5 year old or brave teen will motivate you to get up, get on with it and get through – if not for yourself right now then you’ll do it for them.

No matter how old your kids are, under no circumstances think that they’re too young to know that something’s up.  Explaining your sudden frequent disappearance (not to mention that of your boobs or hair) and everyone’s tendency to cry often may be frightening and shake their world but it won’t be half as bad as if you try to pretend nothing’s happening when they know full well something’s up.  What you say and how you say it will be your own personal journey and there’s some great resources to help you work through this.

Looking after littlies may be beyond you right now so ask for help from Grandparents, friends and your partner if you need it until you get through your treatment.  If your kids are at daycare or pre-school then it’s a good idea to keep them informed of what’s going on at home.

If you’re eligible, help with childcare costs or OSCAR subsidies may be available from Work & Income (WINZ) for anything up to 50 hours childcare subsidy.  See www.winz.govt.nz for details.