My thoughts on having had breast cancer.... it is more than just pink.

I usually write about thyroid cancer, but as I have said before, this is a "2 fer" blog, so today, I will write about breast cancer. I decided to write a blog on this  because this is national breast cancer month and also because it helps me to write about my feelings, and hopefully, what I have to say will help others,too. Let me say that while I appreciate all of the " pink" and well wishes from others, there is so much more to breast cancer than anyone other than a breast cancer survivor could imagine.

I am a three year breast cancer " survivor." I use that word loosely, because frankly my life has changed forever. Most people think that after a person who has had breast cancer has survived a year or two, we should be able to put this behind us and move on. While I am grateful beyond measure for the love and support that I have received from my family and friends- especially during my surgery and chemotherapy- this " thing that happened to me" is forever a part of me. I now deal with issues, both large and small, on a daily basis. Will this shirt fit ? ( translation: will it have a gap in the top), will I ever be able to find a bra that fits and is comfortable? ( after three years, I finally have found one) and the uncomfortable and worrisome thought of getting hit in the chest by someone, accidentally of course, or perhaps getting burned or having frost bite on my chest( I am numb most places on  my chest, and my plastic surgeon warned me about heating pads causing burns and ice packs causing frost bite). It is sort of humorous, but cooking and leaning over a hot burner gives me pause.

Of course, the bigger issue that every person who has had breast cancer worries about ( or people who have had  other cancers for that matter) is the fear of recurrence. I have my twice yearly  breast cancer check up next month and while I dread it, I also realize that afterwards, if everything turns out well, I can relax for a while. I have mentioned in previous blogs that the smell of the hand soap in the oncologists office makes me nauseous. It is the spark that lights the fire of flashbacks for me, I suppose.

One of the most traumatic memories for me, one that is seared in my brain for eternity, to be dramatic, is when my plastic surgeon made his final visit in the hospital before my surgery. I was sitting on the edge of the hospital bed, IV in place," beautiful "hospital gown on, and my husband had just stepped out of the room. My plastic surgeon came in and asked me to take my hospital gown down. He had a black sharpie in his hand, and proceeded to mark all over my chest- around both of my breasts. After weeks of preparation for this day- all of the tests, the doctor visits, talks with my family, reading up on the surgery and discussions with my breast cancer friends, it all  came down to this. The act of marking on my chest made it suddenly all too real. Yes, this is happening to me. Yes, I am losing my breasts. Some well meaning people told me " Oh, they are just breasts! You will get new ones, perky ones!" A word of advice to others, please, please do not say that to a breast cancer patient! My breasts were more than just mounds of tissue and blood vessels. My breasts lovingly nourished both of my children when they were babies. They were a big part of making me feel like a woman. Heck, they made it possible for some of my favorite shirts to fit nicely.

After my breasts were gone, I looked in the mirror and wondered " Who is that person looking back at me?" " Where do I go from here, what do I do now?" To be honest, I am still working on answering those questions. The 3D nipple and areola  tattoos that I had done by Vinnie Myers ( a saint in my book) have helped me tremendously. I really understand when I read about other women getting even more ornate tattoos to cover their mastectomy scars.  We have all lost something irreplaceable. But having the power to put something that we pick out, we control, back on our chests balances the scales a little.

I could never wear pink very well- it clashed with my red hair. But I do appreciate all of  the people that do so in support and honor of all of the people who have had or have breast cancer. But there is more to the story than just pink. And I am still working out the chapters.

The HYPOthyroid and anxiety connection...

I think that most everyone knows about the connection between being HYPERthyroid and having anxiety. What seems to be not as well known, in the medical community especially, is the connection between having anxiety and being hypothyroid. I have been interested in this from a personal stand point, I will admit. I have had thyroid issues for years. For a long time, I went undiagnosed and untreated for thyroid disease, specifically, Hashimotos thyroiditis, which is an autoimmune condition. In Hashimotos , the thyroid gland is slowly attacked by the immune system, resulting in hypothyroid disease. What I did not know at the time of onset of my Hashimotos, was that my body was most likely experiencing surges of thyroid hormones that could cause a temporary hyperthyroid state. These surges of thyroid hormones can produce anxiety and depression. A patient can have one or both of these mood disorders. To be honest, I have never had true depression ( depression lasting days or not caused by a traumatic life event) but I have really struggled with anxiety issues.

Many doctors are pretty quick to prescribe antidepressants, and other medications for anxiety and/or depression. I am not going to discuss depression, except to say that if one has depression, it would be prudent to have a physician check TSH, T3, T4 and reverse T3 at least, in order to rule out thyroid disease that may be causing the depression. It may be that thyroid hormone supplementation could be enough to treat the depression. Or perhaps, treating the thyroid disorder with thyroid hormone could enable the prescriber to use a smaller dose of an antidepressant. There should be no stigma with having mental health issues, but if these disorders are caused by a thyroid function problem, it makes perfect sense to treat that first. Then if other medications are needed, those can be discussed a little later. I will mention that other therapies- talk therapy, exercise, meditation,etc. have been shown to improve depression and anxiety, so I think these are valuable options that should be explored before prescribing medications.

Back to anxiety. My endocrinologist, whom I really like, by the way, does not buy into the hypothyroid and anxiety connection. I have searched for medical articles on this subject, as well as talking to others who are hypothyroid and are having to deal with anxiety. The best article that I have found so far, is an article in the Indian Journal of Endocrinology and Metabolism, 2016, Jul-Aug; 468-474. This was a very small study, and the authors freely admit that because of the size of the study( 100 patients), their results could not be considered conclusive. Still, this study has given me some insight and I think some hope. This study also cited that females who were hypothyroid experienced anxiety more than males in the study. One thing is certain: thyroid hormone and thyroid  function affects the central nervous system throughout a patient's entire life. I will not get too technical here, but thyroid hormone affects the development and action of neurons, the release of serotonin,as well as activity in the brain. Exactly how  thyroid hormone affects brain activity is not yet understood. The fact that thyroid hormone does indeed affect brain activity seems to explain the problems in mood in hypo and hyper thyroid patients. One finding of this study hit a nerve with me. And it reads as follows: " Moreover, an early recognition of an endocrine condition will help minimize psychiatric morbidity and hence improve health ." The important words in this sentence, to me anyway, are EARLY RECOGNITION.

In my opinion, or if you watch public television, IN MY HUMBLE OPINION( IMHO), now that the connection between anxiety and being hypothyroid has been established, how is anxiety treated? Well, there are several medications that can be used. Remember, we are talking about anxiety here, not depression. For those people who have both, using an antidepressant medication along with proper thyroid replacement therapy and hopefully more holistic methods( as mentioned above) may be the answer. If a patient is having anxiety only, there are medications that may offer some help, but they come with several side effects. These are the benzodiazepines ( Valium, Xanax, Ativan,etc), and  beta blockers, to name a few. Holistic treatments mentioned above  may also help with anxiety. I think that knowing what may trigger an anxiety attack and taking action quickly to resolve the feeling of anxiety may be helpful. I did not say it would be easy, just that it  may be helpful.

If one has anxiety, I think that the take away from my blog is that thyroid function testing is a very necessary place to start. Early detection and treatment is  the key to better health. Be your own best patient advocate. If you feel that you have a thyroid problem and your physician will not do the necessary tests, seek another opinion. Keep your test records- they belong to you and you have a right to have copies of them. Keeping records enables you to see for yourself the changes in thyroid hormone levels from one year to the next. There is indeed a hypothyroid/ anxiety connection. Seek treatment and know that you are not alone.