Fatigue & Depression

I have been going through quite a bit of fatigue and depression lately. I am still experiencing fatigue almost every day, so when I do have a burst of energy, I make sure to take advantage of it. On days when my entire body is hurting, I try to remind myself that I had my 4th surgery not that long ago, so I don’t need to be so hard on myself when I just want to rest. Resting has become another problem in the form of not being able to sleep properly. It is not out of the realm of possibility for me to be awake until 2 or 3 in the morning, sometimes even later, at least a few nights a week. I realize that fatigue is linked directly with depression, so I am beginning to understand how everything I have been dealing with within the last few months is all part of the same problem.

Not all of my depression is linked to breast cancer, but most of it is. I was talking to a breast cancer patient the other day, and she was asking me how long it has been since I had finished each portion of my treatment. I hadn’t thought about the timing of everything in a while, so as I was answering her questions, I was surprised that time has passed much quicker than I thought. It has been 11 months since my last chemo treatment, 7 months since my last radiation treatment, and 4 months since my previous reconstruction surgery; at times, it feels like a lifetime ago, but when I am having a bad day, it all seems like it happened yesterday. Even with all of that time passing so quickly, my body and mind are still healing. I have been experiencing what I thought were some of the side effects that I had at the end of chemo again, but chemo ended almost a year ago, so I am beginning to realize that some of them are symptoms of depression, as described below. Luckily, we are going on vacation soon, and the timing couldn’t be more perfect. I need a break; I need time away from everything that has been hurting my heart and soul lately, and I need to get my mind and body back on track, and I will!

Depression may be a side effect of breast cancer and fatigue is often a symptom of depression. Some people may have a tendency to depression, which treatment can make worse. At the same time, fatigue itself can lead to depression. Not knowing why you feel drained week after week, and not knowing that this abnormal feeling is normal for many people going through treatment, can make you depressed.

Treatment for breast cancer may leave you feeling sad, tired, or depressed. These feelings are complex conditions, resulting from and affected by many factors: your cancer diagnosis and treatment, aging, hormonal changes, your life experiences, and your genetics.

If you’re abruptly going through menopause 10 years earlier than you naturally would, with a quick lowering of hormone levels, you may experience feelings similar to postpartum depression.

Sadness is a natural part of your breast cancer experience, something you need to express and move through. If you don’t allow yourself to feel sad and grieve, the unresolved grief gets in the way of feeling better and getting better. You may be having hot flashes and trouble sleeping. You may be feeling overwhelmed or even debilitated. All of these factors can lead to fatigue and depression.

How can you tell the difference between fatigue, sadness, and clinical depression? The symptoms of clinical depression include:

  • an inability to cope
  • an overwhelming feeling of helplessness and hopelessness
  • inertia
  • an inability to concentrate
  • memory problems
  • panic attacks
  • loss of pleasure in what used to make you happy
  • lack of interest in sex or food
  • sleep problems

If you think you’re depressed, talk to your doctor. If your doctor doesn’t have experience treating depression, ask for the name of an accredited psychotherapist. Together you can sort out if what you’re feeling is depression or extreme fatigue. Therapy can help you feel supported and allow you to talk about what’s bothering you. Antidepressant medicines can help ease feelings of sadness and anxiety and help you feel better. An accredited psychotherapist with experience treating depression can help.

Breast Cancer Growth Rate

I came across this article recently and it was really shocking to me. I have always understood that breast cancer grows by cell division, but I had no idea of the timing from when it starts to when you can feel a lump in the breast like I did. I know that the information below is scary, but I am posting this to inform my readers because I truly believe that when it comes to breast cancer, early detection and information are key. If you won’t listen to me, listen to a doctor who makes it clear in the article below that a yearly mammogram is so incredibly important. As you know, I also believe that a monthly self-exam between mammograms is just as important. I don’t want anyone to go through what I have been through in the last 18 months, so if I can help just one reader understand the importance of mammograms then I have done my job.

Speaking of mammograms…my last mammogram was before my first surgery in April 2019. Now that I am over six months out from my last radiation treatment it is time to finally have a mammogram done to make sure that cancer has not come back. My surgeon explained that we couldn’t have a mammogram done any sooner than now because the radiation causes the images to look cloudy. So, next Monday I will have the mammogram done that my surgeon ordered back in February. I am scared, to say the least, but I am trying to have faith that all of the chemo and radiation treatments killed any tiny cancer cells that may have been too small to detect after my first surgery.

Ask an Expert: Breast cancer growth rate

From the expert staff of breast cancer research at the Robert W. Franz Cancer Research Center at Providence Portland Medical Center:

Like a lot of cancers, breast cancer grows by simple cell division. It begins as one malignant cell, which then divides and becomes two bad cells, which divide again and become four bad cells, and so on. Breast cancer has to divide 30 times before it can be felt. Up to the 28th cell division, neither you nor your doctor can detect it by hand.

With most breast cancers, each division takes one to two months, so by the time you can feel a cancerous lump, cancer has been in your body for two to five years. It can certainly seem like a lump appeared out of nowhere – especially if you or your doctor have recently examined your breasts and not felt anything suspicious – but in reality, cancer has simply doubled that one last time necessary to be noticeable. By the time you can feel it, a breast tumor is usually a little more than one-half inch in size – about a third the size of a golf ball. It has also been in your body long enough to have had a chance to spread.

This sounds scary, but what it really underscores is the importance of regular mammograms. These screening tests can usually detect breast cancer when it’s about one-quarter inch in size or smaller – a year or more before it would be detectable by hand. Mammograms also make possible the early diagnosis of some pre-cancerous conditions and early-stage cancers that appear as tiny calcifications (microcalcifications) on mammography but aren’t detectable by physical examination.

It’s important to realize that there are two types of mammograms:

screeningmammogram is performed in cases where there isn’t any known problem. This type of mammogram is used for annual exams.

A diagnostic mammogram is performed when there is a known problem that requires careful evaluation. Diagnostic mammograms provide much more extensive images than screening mammograms, such as views from additional angles and compression, or blow-up, views. Often an ultrasound will be done in addition to the mammogram if there is a palpable lump. Make sure you receive a diagnostic mammogram if you’ve found a lump.

Once a breast cancer gets big, every doubling is significant. If you find a lump, see your doctor as soon as possible. Don’t settle for just a mammogram if the mammogram doesn’t find anything. The next step should be a screening ultrasound, and if those results are indeterminate you need to get a biopsy. Ask your doctor for these tests if he or she doesn’t schedule them.

How Do You Tell People That You Have Cancer?

Telling people that are close to me that I was diagnosed with breast cancer was a very personal and difficult decision. I am sure you are thinking that I am crazy for saying that and I would have agreed with you when I was first diagnosed, but I don’t agree now. Why wouldn’t a patient want to tell their family and friends? Or, what would make a cancer patient regret telling them? It will probably surprise you to know that I have spoken with some cancer patients that didn’t tell anyone, or that after the fact, they had wished that they hadn’t.

Family members, friends, and co-workers are never comfortable hearing that someone they know and care about has received a breast cancer diagnosis. It is a hard subject to discuss and every cancer patient knows that to some degree once they start telling people that they have cancer, the flood gates open with questions and in some cases blame. It is sad but true that sometimes out of fear, people are ignorant enough to ask a cancer patient what they “did or didn’t do to get cancer”. I can tell you that I was blaming myself early on. I was sure that it was my fault, that I had done something wrong and that is why I ended up with breast cancer. I know now that it was ignorant of me to blame myself. I didn’t do anything to cause my cancer, cancer chose me.

Sometimes people stay away because it is easy for them to assume that since someone they know was terribly sick during chemo, that you will be too; or someone they know did not survive breast cancer, so you won’t either. Understandably, they are afraid to be close to you because they think that you will die and it will hurt more if they step into the reality of your cancer so if they don’t talk to you, it isn’t real. I have found myself reminding people that I am still me, that every breast cancer patient’s experiences and outcomes are different, even if they have the exact same diagnosis. So many factors go into how a patient will respond to chemo and radiation treatments as well as undergoing multiple surgeries like most of us do, so it is impossible to predict what will happen. I am happy to say that I am doing well now that I am well over a year out from my diagnosis…I am a survivor!

I didn’t tell anyone right away because my husband and I were in shock and we needed to process what was going on. I also had my first biopsy to go through and I wanted to have the specifics of my breast cancer before sharing the information with anyone. Just a few weeks later once all of the test results were back, I told my family and close friends first through phone calls and private messages. As the news spread of my diagnosis, some people reached out to me immediately and others often times the people I wanted to talk to the most, stayed away from me, not knowing what to say. I can’t blame people for distancing themselves because I understand how hard it is to hear about the pain, endless doctors’ appointments, and everything else that I had to endure both physically and mentally for months on end. I also understand that people think that they would be bothering me or burdening me if they wanted to talk about things that they are going through, but if that is what they are thinking, they couldn’t be more mistaken. Right now, especially while I am laid off from work, I need my friends and family, I need to connect with people.

Being diagnosed with breast cancer has taught me that we never know what tomorrow will bring. Putting off spending time with the people that we care about and love should not be left until tomorrow, or next week or when we think we will have time because time is not on our side. {Yes, I know that the virus we are all dealing with is not helping bring us together, face to face, but there are other ways to communicate.} Sometimes the choices we make will only bring us to feelings of regret in the future, and sometimes it is too late to go back to the cherished moments we should have had with those that we love and value.

Anastrozole Check-up with My Oncologists PA

Today I had a check-up with the PA at my oncologists office to see how I am doing on Anastrozole. I have been taking it for about 5 1/2 months and I have been doing well. I was having problems with dizziness in the beginning so I changed the time of day that I take it from right before bedtime to when I wake up in the morning. I haven’t had a dizzy spell in a few weeks so it seems that my body has adjusted well.

First we went over my labs from the blood that they drew today. My white blood cell count is finally in the normal range, on the low end, but that was good to see as it means that my immune system is getting back to normal. My red blood cell count is still out of range, just a little low, so that goes along with me still fighting fatigue. I had one other value that was high but she said that it indicates that I have allergies to which I said “I don’t have allergies.” She laughed and said that as far as I know I don’t have allergies but I could be developing them….I hope not.

For the first time ever, she actually mentioned my weight but in a good way. She was happy to see that I have lost weight since the end of chemo, which was at the beginning of October last year, 27 lbs lost in total so far. She said that she knew it upset me to gain so much weight during chemo but she said that while going through chemo it is good to gain some weight because my body needed me to eat well. We agreed that my gaining weight helped me get through chemo as well as I did. She was also happy that I have been losing weight while taking Anastrozole because most women complain that they gain weight while  on it, which for me will be 10 years, so I will keep doing what I have been doing to get to my goal weight.

She also asked me how everything went with the second part of my reconstruction surgery that I had 11 weeks ago today. She was happy that my surgeon was able to get me on his schedule so quickly before my medical insurance ran out due to being laid off. She reminded me that it has only been 11 weeks since that surgery and since I have had so much surgery in the last year, it will still take some time for my body to recover from all of the trauma I have been through.

I asked her when the 5 year count starts as it is the main focus now that I am done with my treatments and surgeries. She said that in their office they start the count from when I completed all of my treatments, both chemotherapy and radiation, which was this year at the end of January. I then asked what the next steps are in their care for me as a cancer patient. I will continue to have check-ups every 3 months for the first 2 years after completing treatments, then every 6 months until I get to 5 years after treatments and after 5 years she said that most patients go back to seeing their regular doctor once a year. My chances of recurrence are at their highest until I get to 2 years, then it will drop a bit until I get to 5 years and then it will drop substantially after 5 years without recurrence.

We also talked about my next mammogram which is coming up in August. I am nervous about it and she assured me that especially with this being the first imaging done in over a year, it is completely normal for me to be worrying and nervous. I told her that am paranoid about the cancer coming back so I am checking my breasts often for anything that feels abnormal. But, I also told her that I am well aware that I have been through the maximum treatments for my type of cancer, having had both chemotherapy and radiation, plus having an excellent surgeon who removed all of the cancer; so keep reminding myself that there should not be anything visible in my mammogram.

So all in all I am doing well and getting healthier and stronger as I get further away from having ended chemotherapy, radiation and 4 surgeries. Here’s to another 3 months of continuing to improve! 🙂

Breast Cancer Glossary: 41 Terms You Should Know

When I was first diagnosed with breast cancer it was unimaginably overwhelming in so many ways. My head was spinning with questions and fears and like many newly diagnosed patients, I felt like I needed to quickly learn a new language. Little by little I began to understand my diagnosis and what it meant for me as a breast cancer patient. Now, 16 months later, I have come across all of these terms either through my own experiences, discussions with my doctors or by reading the endless sources of information that I have discovered along the way. In the beginning of my journey it would have been so helpful to have all of the information below in one place for me to reference. I hope by sharing this article I am able to help answer some of the questions you might have as a breast cancer patient or a caregiver to a breast cancer patient.

At the bottom of this article, Monica suggests writing your cancer story basics using this guide. I am finding that quite often people will ask me for this information whether it is in a new forum that I have joined or during a conversation I am having with someone new. I have included my cancer story basics here in this blog post and on my “About Me” page.

My Cancer Story Basics: I was Dx at age 51 w/ ER/PR+, HER2-, IDC. I have had ACT, Rads, and I am on a 10 yr plan w/ HT, Anastrozole. My cancerversary is the date of Dx on February 25th, 2019. I have had a partial mastectomy, port-a-cath insertion, reconstruction w/reduction mammoplasty and insertion of breast prosthesis following reconstruction.

The author of this article, Monica Haro, is the community guide for the breast cancer support app BC Healthline. This particular app has been an amazing source of support for me both while I was in the middle of fighting breast cancer and also now that I am learning to live life as a survivor.

Medically reviewed by Krystal Cascetta, MD — Written by Monica Haro on July 6, 2020

Utterly overwhelmed is how I felt when I faced the uncertainty and devastation of my breast cancer diagnosis 5 years ago.

I dove into online communities to connect, observe, research, and be heard. When I did, I was lost on some of the language. There were so many terms, acronyms, and abbreviations to learn.

Some things that now seem obvious to understand weren’t while dealing with a brain processing the new trauma of my cancer diagnosis.

If you’re wondering what in the world a red devil, foob, expander, and ooph is, I’ve got you.

Here’s Why Exercise Is Crucial in Preventing, Treating Cancer

I struggle with getting exercise into my daily routine not because I am too busy, but because I am still dealing with fatigue from over a year of fighting breast cancer. Everything about my journey has been exhausting both physically and mentally. Luckily I am on the other side of treatments and endless doctors appointments so my energy level is slowly improving. Most days I try to get some form of activity in, even if it is just cleaning part of the house or playing with my dog….it all counts and I make sure to remind myself of that.

Written by Matt Berger on October 20, 2019

Strength training two to three times a week along with aerobic exercise three times a week is recommended for cancer prevention.
  • A panel of experts has released guidelines stating that regular exercise can help prevent cancer as well as help people undergoing cancer treatment.
  • The experts recommend 30 minutes of aerobic exercise 3 times a week and strength training 2 to 3 times a week.
  • Experts say exercise can help prevent cancer by reducing inflammation, keeping weight under control, and boosting the immune system.

Kathryn Schmitz is seeking a paradigm shift.

Schmitz, a professor of public health specializing in cancer at Penn State University, thinks the perception of the ties between exercise and cancer is where the perception of the ties between exercise and heart health was decades ago.

Back then, she said, getting a patient out of bed and moving after a heart attack would be criticized. Today, the benefits of exercise to heart health and recovery are well known.

A similar consensus is emerging in the way the medical field thinks about cancer.

The latest sign in that shift came this week, with the publication of new guidelines that recommend physicians “prescribe” exercise in efforts to reduce the risk of certain cancers and improve the treatment outcomes and quality of life of those with the disease.

“Today if you asked someone with a dad with colon cancer if he should be exercising they’d probably either say no or they don’t know,” Schmitz told Healthline.

Schmitz co-chaired the roundtable — which included experts from the American College of Sports Medicine, the American Cancer Society, and 15 other groups — that put together the new guidance.

The gist of the guidance, published in three papers this week, is that exercise can contribute to the prevention of bladder, breast, colon, esophagus, kidney, stomach, and uterine cancer.

The guidelines also state exercise can help improve survival rates for people with breast, colon, and prostate cancer — as well as the quality of life of those people in terms of reducing side effects of cancer treatment.

How much exercise?

The researchers recommend that people with cancer do 30 minutes of moderate aerobic activity 3 times a week and strength training such as weights 2 to 3 times a week.

Schmitz said originally the researchers looking into that question sought to find out if there were specific “doses” of exercise that could be tailored to different people with cancer.

But the 30 minutes 3 times a week recommendation seemed to work pretty universally.

They still ended up with their goal of being able to “prescribe exercise like a drug,” Schmitz said. “Just turns out that it’s, say, 600 milligrams for everybody, if you will.”

In terms of cancer prevention, the recommended general physical activity guidelines are at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week.

Schmitz says getting more tailored recommendations for cancer prevention is one of the remaining open questions that ongoing research hopes to help answer.

“We don’t know the exact, optimal dose of exercise needed for cancer prevention,” Alpa Patel, the American Cancer Society’s senior scientific director for epidemiology research, told Healthline. “But we know from the evidence to date that the more you do the better.”

Why exercise works

Patel, lead author of the paper that covered the prevention aspects of the new guidance, said how exactly exercise affects cancer prevention is severalfold.

That includes exercise’s effects on reducing inflammation, helping regulate blood sugar and sex hormones, and improving metabolism and immune function.

“Depending on the specific cancer, one or more of those mechanisms may be more important than the others,” he said. “So, for breast cancer, the benefits of exercise are really driven through the impact on sex hormones.”

“It can also affect cancer development or risk through reducing obesity, a risk factor for many cancers,” said Dr. Crystal Denlinger, an oncologist at the Fox Chase Cancer Center in Philadelphia and chair of the National Comprehensive Cancer Network’s panel on survivorship guidelines.

She told Healthline that the exact reasons why exercise affects certain cancers in different ways still needs additional research.

The current recommendations do vary a bit based on personal history, Denlinger noted. But, she said, “at this time, there is no one ‘best’ exercise — anything that gets you moving and active is good.”

She said further trials are under way to evaluate how and when exercise can affect cancer treatment.

The effort underway for Schmitz — through an initiative she started at the American College of Sports Medicine — is pushing to get oncologists to assess and advise cancer patients’ physical activity.

“This is an easy, cheap way to give patients less fatigue and a better quality of life,” she said.