Health

The Emotional Side of Breast Cancer

Published

3 years ago

August 23, 2023

Shaquita Estes recalls being in total disbelief when the doctor told her she may have breast cancer. “I absolutely lost it,” Estes says. “I remember falling to the floor just telling him that I heard what he was saying, that this could not be true.”

Estes, a 45-year-old pediatric nurse practitioner from Palmetto, GA, says she was caught off guard because she didn’t have any family history of cancer except for a grandfather with prostate cancer. While a family history of cancer is a risk factor, cancer can still happen if it doesn’t run in your family. Most women who get breast cancer don’t have a family history of the disease.

As a health care worker, Estes’ medical instincts pushed her to get what felt like a mastitis breast pain, clogged milk ducts that may happen when you breastfeed, checked out. “I knew that I didn’t have mastitis because I was not [breast]feeding.”

In September 2018, Estes was diagnosed with invasive ductal carcinoma, a common type of breast cancer that starts in the milk ducts. It makes up about 80% of all breast cancer cases.

A life-changing diagnosis like breast cancer can dig up a lot of emotions. It’s not uncommon to have depression, anxiety, uncertainty, fear, loneliness, and body image issues, among others. In fact, about 1 in 4 people with any type of cancer may have major or clinical depression and benefit from its treatment. One day you’re just going about your life and the next minute, you’re scrambling to get tests and scans as you try to make sense of complex medical information and your fast-changing reality.

After getting the diagnosis, some women may feel “significant distress,” says Kathleen Ashton, a clinical health psychologist in the Breast Center, Digestive Disease, and Surgery Institute at Cleveland Clinic. “They may not know what the next steps are.”

The word “cancer” itself may be a source of worry for many women, Ashton says. The fears can include worries about treatment costs, anxiety, and uncertainty about how it will impact your life or even your mortality, how the cancer may change your physical body, and how it may affect your loved one’s lives.

After the diagnosis, you’ll meet with your doctor to go over a treatment plan based on the type and degree of cancer you have. Ashton says it’s easy to feel “very overwhelmed,” as there are multiple steps and lots of information to take in. It’s a good idea to take a support person along to help you through it and to take notes on what’s said.

“I really recommend that patients focus on one step of the plan at a time and to remain flexible because sometimes the plan changes as you get more information at each step,” Ashton says. This may help you feel less anxious.

Breast cancer treatments like chemotherapy, radiation, or surgery may bring about a lot of physical changes. Depending on the type of treatment you have, surgical breast tissue removal or reconstruction may result in scars. You may lose hair through chemotherapy. Some people with breast cancer may also have weight gain and go through early menopause. These physical changes may bring about issues with self-image and confidence.

For Estes, losing her hair was a big point of worry. “In the African American culture … it’s really our crown, our strength. It’s who we are,” Estes says. “I had a lot of pride and joy in my hair.” Once Estes started to lose hair, she says she decided to embrace it. “I just went and got it shaved completely off.”

Snehal Ponde also had strong feelings about her hair. “The only thing I thought of was, ‘I don’t want to lose my hair.’ It’s like your hair, your breast — it’s a reflection of who we are as women.”

Ponde, a 37-year-old Indian expat living in Singapore, gave birth to her son in April 2020. Three months later, like Estes, she felt a lump that turned out to be stage IV cancer.

During chemo, she chose to try a cooling cap to reduce hair loss. The cap, which is worn before, during, and after each treatment, is designed to circulate a cooling liquid around your head. The cold temperature may stop the chemo from damaging your hair follicles.

“Right now, I almost have 60%-70% of my hair,” Ponde says. The research on cooling caps has been mixed, with better results from the newer types of these caps, some of which have FDA clearance. There are some theoretical questions about whether the cold temperatures might let some cancer cells stick around in the scalp, but no signals of safety problems in studies so far. If you’re thinking about adding a cooling cap, ask your doctor for their take on them and what to look for. And check on whether your insurance covers the cap’s cost.

For Shayla Wishloff, the sudden sense of uncertainty was jarring. “I thought I had such control of my life. I’m always the girl who had the year planner. I planned my vacations 6 months down the road. I had a 5-year plan, and I was doing it.”

Wishloff, now 25, was 24 when she got her breast cancer diagnosis. She had just finished nursing school in Alberta, Canada and was talking about buying a home, getting married, and having kids. One day, while applying lotion after a shower, she felt a lump in her breast. “Having my nursing background, I was like, ‘Well, that’s not good.’”

Doctors assured her that it’s very rare for someone in their 20s to get breast cancer. Studies show that only 5% of all breast cancers are found in people younger than 40; breast cancer is most often diagnosed in women age 50 and older. But Wishloff’s biopsy led to a diagnosis of an aggressive form of stage II breast cancer. “I thought I could beat it,” Wishloff says.

After 6 months of chemotherapy that she says did not really work, Wishloff got surgery to remove both breasts — a double mastectomy — followed by reconstructive surgery. Wishloff also got radiation treatments to try to kill any remaining cancer cells. She recalls being told there was “no evidence of disease” afterward.

But a few months later, bad news came. Wishloff says that a follow-up CT scan showed multiple tumors in her lungs and breastbone. It was stage IV breast cancer, which can be treated but not cured. Wishloff says that in October 2020, her doctors estimated she had approximately a year to live. “It’s just such a shock. The only way to put is it feels like the whole world is crumbling on you,” she says.

It took a while to come to terms with it all. “I don’t think so far into the future and get so anxious about it,” Wishloff says. “I realize now — today — I’m OK. Today, I’m happy. Today, I can live a good day.”

Going through breast cancer and its treatment may exhaust you physically and emotionally. Having family and friends who act as a support system can be a comfort.

Estes feels fortunate to have close family members nearby. But it’s her best friends who really help lift her up when she needs it. They call themselves the Ta Group.

“It’s five of my best friends,” she says. “We would just get together and pray. I’ll go into my prayer closet — I call it my war room. If I needed to talk, I would just talk to them in there.”

Professional therapy may also help. Check with your health care team if you want a referral. “I think my counselor has really helped me go through everything, all my traumas … and deal with them,” Ponde says.

Talking and bonding with people who are going through breast cancer may help you feel understood and less alone. You can find support groups on social media sites like Facebook and you can join local organizations.

You can also speak to a social worker or your counselor for more resources. When you’re seeking a community, Ashton notes that hearing people’s stories or reading too many negative posts online may make you more anxious. Her advice: Notice what’s helping you.

“Women with breast cancer come into their diagnosis with many strengths, and it’s important to use those strengths along the way to help you in your journey,” Ashton says.

Breast cancer diagnosis and treatments demand a lot from you and your body. You owe it to yourself to take time — even a few moments every now and then — to unwind and take care of yourself.

Here are a few things you can do:

Yoga and meditation. These mindfulness practices can help to lower your fatigue and stress. Any kind of exercise is also a good outlet for stress.
Go for walks. “It could be the worst day of my life, and then I go outside for a walk. That’s the only thing I can do that I know 100% will change my mood,” Wishloff says.
Imagery. Many people with cancer find imagery exercises can help manage pain and stress. To get started, close your eyes and think of a happy image in your mind. You can also think of an activity you like and let your mind linger. This may make you feel calmer.

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Health

Putting a Hole in Our World

Published

2 years ago

May 17, 2024

Desk Report

May 10, 2024 – When we’re young, we take our macula for granted. At the center of our retina – the deepest layer of the eye that’s chock-full of photoreceptors and that confers color to our world – the macula is like a high-resolution camera. As light hits our eyes, the retina’s macula recasts our world in a bloom of color with astoundingly high visual sharpness.

But as you age, your vision dulls. What once stood out sharply becomes foggy, like condensation on a windowpane. After some time, a coal-black smudge or cloudy circular area begins to affect your central vision.

This effective blind spot widens over time if left untreated. What remains is a “macular hole” in the center of your retina.

This unfortunate series of events marks the advanced stage of age-related macular degeneration, a dangerous retinal disease that affects about 20 million people in the U.S., and nearly 200 million people worldwide.

And it’s not getting better. Estimates are that by 2040, the disease may affect nearly 300 million people worldwide. We are very limited in our ability to treat or prevent it. Read on for what to know.

First, What Causes Age-Related Macular Degeneration?

AMD’s causes are varied, and whether it will affect you is mostly determined by age and genetics, said Marco Alejandro Gonzalez, MD, an ophthalmologist and vitreoretinal specialist in Delray Beach, FL.

Because of the different cocktails that we have in terms of our genetic makeup, some people’s photoreceptor cells in the macula “basically start to shut down,” he said.

AMD’s development involves over 30 genes, and if you have a first-degree relative – parent, sibling, child – who has the disease, you’re three times more likely to get it, too.

Gonzalez explained how the expected rise to 300 million cases by 2040 is due mostly to improved diagnostic tools, along with the fact that the world is getting older and living longer. (Usually, an optometrist can detect signs of AMD during a routine eye exam.)

Eye experts still struggle to stop AMD’s most harmful sign – the cause of those muddy, milky, or even coal-colored circles in your central vision: geographic atrophy.

Geographic atrophy can occur in either of the two forms of age-related AMD: “dry” AMD and “wet” AMD.

Nearly every case of AMD begins as the dry kind, affecting 80% to 90% of AMD patients.

Retinal disease expert Tiarnán Keenan, MD, PhD, offered a vivid image of geographic atrophy for those who have dry AMD.

“As time passes, the circular patches of GA expand like a brushfire, taking more and more vision with it, often to the point of legal blindness,” he said.

A researcher in the Division of Epidemiology and Clinical Applications at the National Eye Institute, Keenan recently led a study that tested the efficacy of the antibiotic minocycline in slowing geographic atrophy expansion in dry AMD. The study operated on the grounds that the body’s immune system could be at play in developing the disease.

When your body’s immune system is overactive, microglial cells (central nervous system immune cells) can get into the sub-retinal space and possibly eat away at the macula and its sensitive photoreceptors.

Though minocycline had been shown to reduce inflammation and microglial activity in the eye in diabetic retinopathy, it didn’t slow the expansion of geographic atrophy or vision loss in patients with dry AMD during Keenan’s study.

When asked if microglial activity could have very little to do with the atrophy expansion, Keenan said it’s something to consider: “Maybe microglia are just there as bystanders clearing up the debris … so inhibiting them is less likely to slow down progression.”

In future drug trials, “maybe it’s possible the minocycline or another approach to target microglia would be helpful, but it would be needed in combination with some other therapy and be ineffective by itself,” he said.

Two Sides of the Same Disease

In dry AMD, Gonzalez compares macular degeneration to the loss of pixels on a screen. “Some of those pixels burn out … and that’s the way you lose vision classically in the dry form.”

Wet AMD is a more progressive form of the disease. It causes abrupt vision loss due to abnormal blood vessel growth.

“If you don’t treat wet AMD quickly, it’s game over,” warned Gonzalez. “Wet macular degeneration is the quicker process of vision loss because these blood vessels wreak havoc.” These new blood vessels bleed, causing fluid to build in the macula, which ultimately leads to scarring.

Gonzalez shed light on why wet AMD develops. “The wet form, for some reason, is the body’s last-ditch effort to try to kind of ‘help’ a dying macula. … When these blood vessels start to grow under the retina, they quickly destroy the architecture of the macula.”

Stopping the Bleeding in Wet AMD

Though wet AMD is rarer, it’s more treatable than dry AMD. Signs and symptoms can be eased with various therapies injected into the eye.

Putting it simply, Gonzalez said these therapies to treat wet AMD “all basically do the same thing. They make these new blood vessels regress temporarily before they cause damage to the macula.”

The injected medication clears away those blood vessels and restores the architecture of the macula. People can recover some vision in this way, but it’s only a temporary tune-up, and shots must be given as often as once a month.

“Degeneration of the cells is still the main problem. You’re not stopping that. But degeneration itself is a lot slower than actual vision loss associated with these blood vessels.”

The Struggle in Developing New Treatments

According to Keenan, “nobody has been able to stop geographic atrophy from happening” in either form of AMD. “So, that’s the main work in the field with trials.”

In December 2023, the FDA approved two new drugs: Syfovre and Izervay, both of which only slow geographic atrophy. Degeneration still happens, regardless.

Keenan explained how these two new drugs are “complement inhibitors … given by injection into the eye once a month or so.”

“Complement” refers to the body’s complement pathway, a trigger that activates a cascade of proteins in enhancing immune response.

Clinical trials showed Syfovre slowing the rate of geographic atrophy by up to 22% over 2 years, and Izervay up to 14% over 1 year.

Though these drugs are a new weapon against this troublesome affliction, they aren’t without their complications.

“Anytime you give an injection in the eye, there’s always the risk of an infection because you’re introducing something from the outside. So that’s the biggest risk,” explained Gonzalez.

An infection is uncommon, but potentially devastating, as you can lose your eye altogether. There’s also the chance of a damaging reaction to the shot.

“You have to pick and choose your patients,” said Gonzalez. “Not everybody is a good candidate for those new shots … and the patient is never going to see better. … It’s a harder sell than the ones for wet AMD.”

A Common Protective Measure

Keenan and Gonzalez both have a fair degree of confidence in reducing the risk of AMD with vitamin therapy.

As a bit of background on how vitamins were found to act as a sort of preventive measure, Gonzalez said, “In the early and late ‘90s, there were series of studies which were called the age-related eye disease studies.” These are now referred to as AREDS 1 and AREDS 2.

Researchers proved that a certain cocktail of vitamins slowed down degeneration. The most is a combo of antioxidants: vitamins C and E and lutein and zeaxanthin, all of which are in the AREDS 2 formula.

People who took these vitamins had a lower chance of losing their vision over the next 2 to 5 years. “[The combo] seems to be complementary and additive … with a combined treatment effect of 55% to 60%, an excellent safety record, and very low cost,” Keenan said.

Gonzalez recommends the AREDS 2 formula of vitamins to every patient of his. “It’s such an easy thing to take, and the downside is minimal.”

Unfortunately, if your genes make you more likely to have the condition, a change in diet or vitamin use could have no effect.

Dire? Possibly. But not all is lost in this fight.

Vigilance with AMD and What to Do Next if You’re Diagnosed

Gonzalez is adamant in educating his patients before time has run out on treating AMD. Recognition is key. “The most common reason a lot of these people get to me ‘too late’ is they don’t realize there’s a problem.”

He explained a typical scenario: “Let’s say you have macular degeneration in both eyes at different stages. One of your eyes starts developing wet macular degeneration … so the better eye takes over and you may not notice there’s a problem.”

Even after a patient is diagnosed with AMD, they usually see a specialist only twice a year. Gonzalez often tells his patients to cover one of their eyes to make sure their vision is intact in both eyes. “You’ll be able to pick up on subtle differences” in each eye, he said.

This type of self-care and vigilance can be the difference between successfully living with and treating the disease for the rest of your life, and trying to get help when it’s simply too late.

For wet AMD, as mentioned before, a round of injections is basically what everyone does. Without quick, invasive treatment, the point of no return approaches rapidly.

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Health

Federal Experts Talk Bird Flu ‘What Ifs’ in WebMD Live Event

Published

2 years ago

May 17, 2024

Desk Report

May 16, 2024 – Multiple U.S. agencies are working to contain the recent bird flu outbreak among cattle to prevent further spread to humans (beyond one case reported in early April) and use what we learned before, during, and after the COVID-19 pandemic to keep farm workers and the general public safe.

Fingers crossed, the bird flu will be contained and peter out. Or the outbreak could continue to spread among dairy cattle and other animals, threatening the health and livelihoods of farmers and others who work with livestock.

Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.

With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.

Communication with the public “about what we know, what we don’t know, and ways you and your family can stay safe is a priority for us at CDC,” said Nirav D. Shah, MD, JD, the CDC’s principal deputy director. “We at the federal level are responding, and we want the public to be following along.”

People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.

It is essential to not only stay informed, but to seek trusted sources of information, Shah said during “Bird Flu 2024 – What You Need to Know,” an online briefing jointly sponsored by the CDC and WebMD.

An ‘Experimental Hamburger’

If one take-home message emerged from the event, it was that the threat to the general public remains low.

The retail milk supply is safe, although consuming raw or unpasteurized milk is not recommended. “While commercial milk supply is safe, we strongly advise against drinking raw milk,” said Donald A. Prater, DVM, acting director for the FDA’s Center for Food Safety and Applied Nutrition.

As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.

For years, federal inspectors have purchased and tested meat at retail stores, said Eric Deeble, DVM, USDA deputy assistant secretary for the Office of Congressional Relations. So far, H5N1, the virus behind bird flu, has not been detected in beef.

The USDA took testing a step further and recently cooked ground beef from dairy cows in their lab. Using what Deeble described as an “experimental hamburger,” the agency showed cooking beef to 165 F or higher kills the virus if it ever becomes necessary.

The federal government now requires all cattle be tested and be free of bird flu virus before crossing any state lines. The government is also reimbursing farmers for veterinary care and loss of business related to the outbreak, and supply personal protective equipment (PPE) like gloves, masks, and face shields to workers.

Vaccination Not Recommended Now

Federal scientists know enough about H5N1 virus to create vaccines against it quickly if the need arises. It’s more about planning ahead at this point. “Vaccines are not part of our response right now,” said David Boucher, PhD, director of infectious diseases preparedness and response at the Administration for Strategic Preparedness and Response.

If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.

An event attendee asked if the seasonal flu shot offers any protection. “Unfortunately, the flu shot you got last year does not provide great protection from the avian flu,” Shah responded. “It might do a little bit … but that is the vaccine for seasonal flu. This is something more novel.”

Treatments Stockpiled and Ready

Antiviral medications, which if given early in the course of bird flu infection could shorten the severity or duration of illness, are available now, Shah said. The dairy farmer who was infected with bird flu earlier this year responded to oseltamivir (Tamiflu) treatment, for example.

When it comes to bird flu symptoms, the fact that the only infected person reported so far this year developed pink eye, also known as conjunctivitis, is interesting, Shah said. Officials would have expected to see more typical seasonal flu symptoms, he added.

“Influenza is not a new virus,” Boucher said. “With this strain of influenza, we are not seeing any genetic markers associated with resistance to antivirals. That means the antivirals we take for seasonal influenza would also be available if needed to treat H5N1.”

ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.

“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”

Science in Action

The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.

“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.

Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”

For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.

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Health

Federal Experts Talk Bird Flu ‘What Ifs’ in WebMD Live Event

Published

2 years ago

May 16, 2024

Desk Report

Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.

With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.

People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.

An ‘Experimental Hamburger’

If one take-home message emerged from the event, it was that the threat to the general public remains low.

As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.

Vaccination Not Recommended Now

If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.

Treatments Stockpiled and Ready

ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.

“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”

Science in Action

The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.

“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.

Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”

For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.

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