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You Can Get Through This
Your doctor told you it was breast cancer. So now what?! You'll need plenty of essential advice—the kind that only comes from someone who's been there.
In Just Get Me Through This! Deborah A. Cohen and Robert M. Gelfand, M.D. help you deal with all the ups and downs of the breast cancer experience. From the shock of diagnosis to getting through treatment to getting on with your life, they pack it with plenty of straight...
You Can Get Through This
Your doctor told you it was breast cancer. So now what?! You'll need plenty of essential advice—the kind that only comes from someone who's been there.
In Just Get Me Through This! Deborah A. Cohen and Robert M. Gelfand, M.D. help you deal with all the ups and downs of the breast cancer experience. From the shock of diagnosis to getting through treatment to getting on with your life, they pack it with plenty of straight talk and practical tips. This newly updated edition also includes advice from two prominent breast cancer surgeons.
The latest data on hormonal treatments
How cornstarch can help you breeze through radiation
Why a calendar can help you get through chemotherapy
Information on the latest drugs used as part of chemotherapy
How to ease back into an intimate relationship
Who might be your best ally when you're feeling blue
The surefire way to beat insurance and workplace hassles
What medical professionals say about everything from surgery to soy
Each step of the way, this wise and witty companion will be there with unfailing inspiration and heart-to-heart support. It's also simple to use, with an accessible format—to make even the toughest days a whole lot easier.
A Harvard Business School and Smith College graduate, marketing executive Deborah A. Cohen was, like so many others, going about her life as a young and healthy woman when she was unexpectedly struck with a diagnosis of breast cancer. As a result of her illness, the Wisconsin native became active in several breast cancer advocacy efforts, including "Climb Against the Odds, " a Cancer Coalition's Leadership Education and Advocacy Development Program, and Peer Review Committees for the American Cancer Society's research programs. The research and writing of Just Get Me Through This! was a natural next step for Cohen in her commitment to helping others cope with and battle this disease.
Robert M. Gelfand, M.D., is an oncologist with a private practice in New York City. He is a Clinical Assistant Professor of Medicine at the Weill-Cornell Medical Center and at New York Presbyterian Hospital, where he also teaches. He received his undergraduate degree from the University of Pennsylvania and his medical degree from the State University of New York at Brooklyn. He completed his residency in internal medicine at Mount Sinai Hospital and a fellowship in hematology and oncology at The New York Hospital-Cornell University Medical Center. Dr. Gelfand is married and has three daughters.
Faith A. Menken, M.D., is a surgeon practicing at New York-Presbyterian/Weill Cornell Medical Center in New York City. She went to medical school at Cornell University Medical College and did her internship at Mount Sinai Hospital and her residency at the New York Weill-Cornell Medical Center. She lives in New York City.
Eugene J. Nowak, M.D., is a surgeon practicing at New York-Presbyterian/Weill Cornell Medical Center in New York City. He went to medical school UMDNJ/New Jersey Medical School and did his internship and residency at the New York Weill-Cornell Medical Center. He lives in New York City.
There is no good way to receive the news that's the single fear beyond your worst dreams—that you have cancer. No, not somebody else, but you. This chapter will cover a few ways to handle this nightmare over the first few days, in terms of:
Comprehending the news yourself, and communicating it to those few people who need to know as soon as possible, both for your sake, if only to be able to vocalize it, and theirs.
Reacting to the news, and a few ideas for giving yourself a helpful perspective on the situation.
Spreading the news, and determining how broadly and by what means to expose yourself to the "outside" world.
COMPREHENDING AND COMMUNICATING THE NEWS: AN UNEXPECTED TIDAL WAVE
Malignant Cells: Are Those the Good Ones or the Bad Ones?
It's 4 P.M. on a Thursday afternoon, and I'm waiting for a meeting to begin in my office. The phone rings and I decide to answer it while I await my guest. I had been to see a "breast specialist" forty-eight hours earlier for a biopsy on a lump I had found on the side of my breast, but to be honest, I hadn't thought twice about it since. He had reassured me, "It's probably nothing. With women your age, most likely—80 percent chance—it's just a fibrous knot." I had no family history, knew nobody who had breast or any other cancer in my age group, so I had just put it out of my mind.
No more; actually, never again. When I answered the phone, he got straight to the point. "Hello, this is Gene Nowak. I'm sorry to tell you this, but the lab tests showed some malignant cells in your biopsy, which will require treatment." Malignant? Are malignant cells the good ones or the bad ones? I could tell by the tone of his voice that malignancies didn't exactly bring you the winnings of a lottery ticket, but what did he mean? Did he mean cancer? I had only known two people with cancer, and they were older relatives of mine, my grandfather and my uncle, more than ten years ago each. I knew that "lumps," tumors, or cysts—whatever you call them—were classified as either malignant or benign, but I didn't know which was okay and which meant cancer. It just wasn't on my radar screen. It was irrelevant to my young, healthy, active life. Treatment? What does that mean? Is it surgery? Or does it mean lots of other medical "procedures" that are terrifying, so the doctors don't tell you the potentially far-reaching implications of them now, because you have enough to swallow today? My head was spinning.
So, I queried, "Dr. Nowak, does this mean I have c-c-c-c-cancer?" And he responded, "Yes, unfortunately it does. Why don't you come see me tomorrow morning when I have some time to sit with you and thoroughly discuss your alternatives." Tomorrow morning? Can I wait until then? Will I still be alive!? I was in shock. I managed to get out, "Okay. What time?" Then I put the phone down. Now the entire room was spinning. I was shaking and my heart dropped to my stomach. I called my mother. "Mom, the biopsy is back and it shows some malignant cells." "What???" she responded. "Mother, I have breast cancer," I replied, deliberately pronouncing each word. And as I hung up the phone on her because those were the only words I could muster, my meeting guest was standing at my office door. I looked up and said, "I have to cancel our meeting and go home. My doctor just told me I have cancer." And I picked up my coat to leave. Yes, malignant cells are the bad ones. And there, I had even said the "c" word three times. As I left the office, I knew that somehow my life had changed forever, but I was not yet quite sure how. All I knew was that I felt as if I had been smacked in the face by a tidal wave. Somehow, I would have to pick myself up and put myself back together again.
There Are Many Roads Leading to "Suspicious."
If you're reading this book, unfortunately you may have realized that there are many roads which can lead your doctor to mutter something about "suspicious ____" (fill in the blank). It could be several alternatives: a "lump" you found yourself, either intentionally or accidentally; a "thickening" that your doctor found upon examination; or a mammogram where something caught the doctor's attention. Whatever the pathway there, the next step is typically a biopsy. You must understand the role of the biopsy, and what information you can glean from it before considering your surgical options, if that is the appropriate route. Remember, early-stage cancer is very treatable, with extremely high survival rates. In a strange sort of way, think of yourself as lucky that your doctor was suspicious. It may have saved your life.
Getting Your Lab Report ... like Remembering Where You Were When JFK Was Shot.
Just accept that you will never forget the moment your doctor received the results of your lab test, and had to break the news to you. Just as every American adult has a vivid snapshot branded in their memory of exactly where they were and what they were doing when they heard the news that John F. Kennedy was shot, so will you have an indelible imprint of where you were and how you were told that you have cancer. Just as JFK's assassination became a significant moment in American history, your news will become a part of your heritage, your strength, who you are. No matter how much you want to rewind the clock and erase it, you can't. Cancer is now part of your history.
A Dose of Quiet Time Is the Best Medicine for the Ordeal Ahead.
No matter what your point of origin, be it your family physician, your gynecologist, a breast specialist, or even a dermatologist, if you are reading this book, all roads have led you to this shocking crossroads. Like me, you now have cancer as a relevant term in your life—for the rest of it! However, as you will see throughout this book, this news is not a destination, or an end, but the beginning of a new journey—a journey that will redefine who you are and what you want from life, a journey that has obstacles, but also high points, and a journey that many others will share with you and help you endure. However, in the immediate aftermath of receiving your diagnosis, allow yourself some moments alone to just sit and let it sink in as much as it can. Maybe you already have by the time you're reading this. But if you haven't, get away to places that make you feel good. If you like art, go to a gallery or museum. If you like the outdoors, go for a hike or walk in the nearest park. Don't necessarily do anything yet. Look at the surroundings you've chosen, and realize how little you actually see on a daily basis, until news like this makes you wake up to the details of the world around you. Realize how lucky you are just to be sitting there. These moments alone will allow you to get your head clear enough to understand what is happening to you, determine who you need to share your news with, in what order, how, and when. And if you haven't already, use some of this time to make lists of all the questions you want to ask your doctor and all the people who can possibly help you and might know something about your new disease.
A Three-Phase Plan for Letting the News Sink in.
The news that you have breast cancer cannot be comprehended in a single dose. It's something that may happen in phases over several days—easing into your consciousness, and understanding that, "Yes, they are talking about me." And while you will come to understand that fact, it will actually take months, perhaps years, to fully comprehend the implications of that little piece of news. So, after that initial life-changing phone call from your doctor, here's a simple three-phase plan that I used to handle myself in the transition from healthy person to breast cancer patient (at least temporarily):
Phase 1. Building Your Inner Circle: A State of Shock as the Means to Maintaining Composure.
First, determine who in your immediate world needs to know about this right away, if only to keep you from crumbling emotionally. Your list might include traditional family members such as your spouse/significant other, children, siblings and parents. But think carefully. Your traditional family may not be as much support as you need, for any number of reasons—they won't handle the news well themselves, they are preoccupied with illnesses or life challenges of their own, they are geographically distant, etc. Perhaps there are a few other people who should be included in this "inner circle" of support, people who you know will provide that rock-solid pillar of emotional stability that you'll need for the next several months. Consider them surrogate family. Choose about four or five people. See them in person, if possible, so they can see you, touch you, and know that you are the same person. Otherwise call them. But regardless of how you contact them, please soften the shock a bit by prefacing your news with a comment like, "I have something to tell you, but please hear this first ... I will be fine ..."
Despite vocalizing your news, you might still be in shock and not believe this is happening to you. Like me, you might not have even shed one tear yet. That's okay, you're numb. (Or maybe you have. And that's okay too.) Even as I tried to sleep that first night, I didn't cry. But I did lie awake all night, shivering so uncontrollably that my teeth chattered, out of terror, fear, and uncertainty of what lay ahead....
Phase 2. First Cry, See Your Doctor ... Then Do Something Spectacular.
As the numbness wears off and reality sets in, you might start to cry, and have moments when you just can't stop. That is absolutely normal. After a while, you'll feel the need to pull yourself together. I found that two things helped put a stop to my crying. First, have the consultation with your doctor to identify all the issues you need to address, and determine the options you have to remove the cancer. Bring someone from your "inner circle" with you to take notes on what the doctor recommends. In your state of mind, you might be listening, but you won't hear, let alone comprehend, everything.
By just knowing that there are a lot of options for you to eradicate this cancer from your body and your life, you will feel much better. The doctor might discuss lumpectomy versus mastectomy, radiation, chemotherapy, even hormone therapy. Yes, it is terrifying, but it also can provide a strange sense of calm. Although I had never been in a hospital in my entire life—except the day I was born—I felt great relief knowing that soon I would have surgery to get the cancer out of me. In fact, the surgery was scheduled for a few weeks later, but I was so panicked that the cancer was multiplying exponentially by the minute that I asked the doctor to move the surgery date sooner. Eight days later, I had a lumpectomy and axillary lymph node dissection. (See the discussion in Chapter 3, "Deciding on Surgery.")
The second approach is to do something that absorbs all of your concentration. After a doctor's visit that airs all the issues you'll have to address over the next several months, do something spectacular, something completely out of the ordinary of your daily routine. Do something that takes your full attention, that raises others' expectations of you, that has absolutely nothing to do with your current trauma. In my case, I had to go to work and, in fact, had scheduled interviews with senior executives for a book project we were deep in the midst of. So I walked out of the doctor's office, wiped my tears dry yet one more time, and pulled out the company's annual report on the way to their offices. After all, I needed to know what the company did before I could intelligently interview! I had to be "on" and could not re-schedule. So, with eyes as pink as the magenta suit I was wearing that day, I conducted my interviews, just as if life were "normal."
If you are fortunate enough not to have to go to work, then do something that will make you smile, but make sure you are around other people to distract you. Take your children to an amusement park. Have an extra-long exercise session at your gym to make yourself feel really good. Work on any community activities you might be involved in that make you feel good about helping others less fortunate than you. Just don't think about yourself for the time being.
Phase 3. Expand Your Inner Circle: Break the News, Be Surprised.
By the time you move into the third phase, you may be composed enough to start breaking your news to a wider circle of people. While you might worry that telling others will make you feel like a leper, believe it or not, it will make you feel better. I decided to expand my initial inner circle by calling my six closest friends in the world, regardless of where they lived, to tell them the news, but also tell them that I was going to really need them to be there for me during the coming months. Guess what? Of this small sampling of women, women whom I thought I knew so well, each had an acquaintance or coworker who had been through breast cancer and was completely fine! My own spontaneous sample had a survival rate of 100 percent! They even told inspirational stories of women who had gone on to marry, have children, start new careers, etc. This was great! Not only did I no longer feel all alone in the world, but I learned very early that plenty of women do get through this experience (hence, my title), and that my friends would be there to help me.
Determine who else you might want to tell your news personally rather than having them hear indirectly by word-of-mouth. However, make sure that these are people who will be supportive, optimistic, and hopeful. Let them know that, as part of your inner circle, they will be counted on to play several roles for you over the coming months. (See page 3, "Communicating the News.") You don't need to pick anyone else up off the floor right now.
It's Only Two Easy Syllables, but It Might Take Some Time to Be Able to Say the "C" Word.
The word cancer is everywhere in our society. On a nearly daily basis, the news bombards us. We are informed of some new medical treatment for some type of cancer, made aware of some fundraising effort for cancer research, or reminded of yet someone else who has been diagnosed or passed away from cancer. But when the word becomes personally attached to your own individual identity, it becomes much more difficult to verbalize. It may take you several weeks. I started by explaining, "I have malignant cells," then graduated to admitting, "I have a hard time saying the c-word, but I need to have surgery," and finally was able to say, "I have breast cancer, and need to go through treatment." Find your own comfort level over time with divulging the "c" word.
How Can I Be Sick? I Feel Great! A Bit of Healthy Denial Is Just Fine.
Your initial response to the doctor's unfortunate news might be exactly this. Sorry, cancer doesn't discriminate, but your response is very typical—denial. You want to deny that cancer could find its way into your busy, fulfilling life, when you are so energetic and strong and feel great. You may have never even had any other "female" health conditions before, so this must be a mistake. Unfortunately, breast cancer doesn't provide any warning until the tumor appears, and even then is not generally associated with any pain or discomfort. So, you refuse to believe that this could be happening to you.
Denial is the first stage of the grieving process of denial, anger, and eventual acceptance. It is a natural human emotional response, and must be balanced between constructive and destructive aspects. Use your denial in constructive ways to keep your attitude positive, to keep your life as "normal" as possible, to refuse to believe that you might die. You are entitled to a bit of healthy denial, and inevitably will move through it to accept it in your own time frame and on your own terms. It is a loss to be grieved—a perceived loss of femininity and sexuality, a loss of a sense of invincibility and immortality, and in the case of mastectomies, a physical loss of part of your body. Nobody can deny you the entitlement to grieve and experience a sense that your own body has betrayed you. However, don't let it become destructive. Don't let denial paralyze you to the extent that you don't seek out advice regarding treatment and hopeful eradication of this disease from your body as soon as possible! And don't hesitate to seek out support groups even if you think you're really "fine" with it.
Excerpted from JUST GET ME THROUGH THIS! by Deborah A. Cohen Robert M. Gelfand Eugene J. Nowak Faith A. Menken Copyright © 2011 by Deborah A. Cohen and Robert M. Gelfand. Excerpted by permission of KENSINGTON BOOKS. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
A Note from the Authors ix
Foreword Robert M. Gelfand xii
Foreword Faith A. Menken Eugene J. Nowak xiv
Part I The Diagnosis
Chapter 1 Managing the News 3
Comprehending and Communicating the News: An Unexpected Tidal Wave 3
Reacting to the News: It's All in Your Attitude 13
Spreading the News: Exposing Yourself to the World 18
Chapter 2 Swinging into Action 31
Gathering Information: Becoming an Instant Expert 32
Establishing Support and Coping Mechanisms 46
Building Your Health Care Team: A Critical Element in Winning This Game 56
Rules of the Road for Family, Friends, and Other Participants 65
Part II Surgery
Chapter 3 Deciding on Surgery 71
Evaluating Your Options: The Best Results for You 72
Financial and Insurance Implications: Not What You Need Right Now 82
Chapter 4 Undergoing Surgery 87
The Hospital Visit 87
Chapter 5 Recovering from Surgery 93
The Quick Road to Recovery 94
Long-Term Implications: Daily Reminders 101
Surgery Results: Adding to the Information Base 105
Rules of the Road for Family, Friends, and Other Participants 112
Part 111 Treatment
Chapter 6 Deciphering Treatment Alternatives 117
Chemotherapy and Radiation: The Theory behind Each 117
Tamoxifen: The Original Hormone Option 125
Aromatase Inhibitors: The Other Hormonal Option 128
Chapter 7 Managing Treatments: Chemotherapy and Radiation 131
Managing the Process of Chemotherapy Treatments 131
Managing Physical Side Effects: Head-to-Toe Advice 139
Managing the Process of Radiation Treatments 168
Managing Physical Side Effects: Local Area Advice 174
Balancing Work 181
Rules of the Road for Family, Friends, and Other Participants 187
Part IV Getting Back to Life
Chapter 8 Ending Treatment 193
Leaving the Comfort of Your Regimen 193
Five-Year Follow-Up Visits: What to Expect 196
Longer-Term Issues: The Aftermath 203
Transitioning Back to "Normal" 207
Chapter 9 Maintaining a Healthy Lifestyle: The long-Term Outlook 215
Nutrition: Looking at Food in an Entirely Different Way 215
Alternative Medicine: It Really Can Help 225
Rules of the Road for Family, Friends, and Other Participants 237
Some Parting Thoughte 241