(30) Life after Breast Cancer

My range of motion has been affected by lymphedema. What can I do?

Most patients experience a limited range of motion in the arm from which lymph nodes were removed. Discomfort in the axilla region, down the back side of the arm and sometimes generating down into the entire arm, is often resolved after healing takes place but still sometimes persists. Lymphedema, a chronic condition that can be treated but not cured, occurs when lymph in the arm is unable to go back into the body to be dissolved. It creates swelling, pain, and discomfort. The arm with lymphedema may appear larger than the other. Approximately 30% of breast cancer patients who have undergone lymph node removal will get lymphedema. Some lymphedema is mild and can be managed with manual and physical therapy, but some cases are severe and cause considerable pain for the patient. In severe cases, the arm, and sometimes the hand, becomes large, swollen, and painful. Women may be unable to wear clothes with tight sleeves. They must wear a heavy bandage on their arm and a heavy glove on their hand. The bandages may be unattractive, making the individual feel unattractive. Although some spouses are supportive by providing bandaging and care, the lymphoma may still present a deterrent to feelings of sexuality and sensuality and can interfere with lovemaking.

A new and exciting organization, called Lymphediva (www.lymphedivas.com), makes specially designed compression sleeves from colorful, sexy, and comfortable material.

They offer interesting fashionable prints from wild leopard skin to bright fuchsia and paisley. Lymphediva is a family-owned company that is run by parents whose daughter died of breast cancer; their mission is to enrich the lives of breast cancer survivors, to add to their quality of life, and to help improve their sexual self-esteem.

Term:

Axilla region – Armpit, underarm, or oxte.

What about breast cancer sexuality for the single woman or parent?

Being a single parent combined with a breast cancer diagnosis makes for a very difficult situation. Concerns include child care, transportation, and helping the child to feel safe. If the children are teenagers, there may be issues of unmet expectations. Teens need their mothers, but their mothers may be occupied with treatment and recovery.

If you are in a new relationship, you may receive added care and support; however, if your new partner is overwhelmed, you may feel alone. With so much uncertainty in your life, you may be unable to devote the time, energy, and attention to a relationship. Despite this, some woman meet a new partner while undergoing chemotherapy and enjoy a long-lasting relationship.

If you have small children in your home, they are going to need their mother’s attention and time. They may be afraid of your illness, your inability to take care of them, your return to the hospital, or death. If you are not in a serious relationship, dating may need to be put on hold until you complete treatment and are feeling healthy. Single women may be concerned about disclosure. When do you tell a new love interest that you have had or will have a mastectomy or that you may not be capable of having children? This is a personal decision. Clearly, the issues of bodily changes should not be disclosed immediately before going into a sexual act with your new partner. Remember that not all partners will be supportive. It is good get mentally prepared for several different reactions, one of which may be rejection.

Magnolia Myrick:

So there I was: a groovy single chick with an active social life in New York City-with breast cancer, which is very not groovy. I just decided I would hold my head high, wig and all, and keep myself out there in the dating world as much as I felt up to it. I usually waited until I’d gotten to know him a bit to talk about the cancer. And if it never got that far then, it wasn’t an issue anyway. If he ended the relationship because he was put off by the cancer, then he’s got integrity issues, and I don’t want him anyway. I hate to say that I do believe this happened a couple of times (and one of them was a doctor). But listen, this is the kind of thing I want to know about someone sooner rather than later. Anyone can be a fair-weather friend. I want the through-thick-and-thin kind of friend, and so do you.

In retrospect, it probably would have been easier to skip dating while I was in treatment, but it would have been such a lifestyle change for me that it might have made me more self-conscious than I already was. It’s not a straightforward issue, and your decision would depend on what your existing social life is like and what you want it to be during treatment. And hey, taking it one day at a time is always a good decision.

If you’re in a relationship, the question becomes what if we stay together, or marry, and the cancer comes back? We have to talk about this. He could be in the position of becoming my caretaker. It’s a big deal. It’s also worth pointing out that he might get cancer, or be hit by a bus, and that I might become his caretaker. They don’t put that line in there about “in sickness or in health” for nothing. I’m not a therapist, but it seems to me you need to figure this out about anyone you are seriously involved with. And if you don’t like what you’ve figured out, bye-bye birdie.

What about women in same-sex relationships?

Same sex-relationships face many of the same stressors as heterosexual relationships. If the relationship is “solid” emotionally before a breast cancer diagnosis, it will persist after the treatment and recovery process. Conversely, unstable relationships may falter and even end under the turmoil of diagnosis and treatment. A same-sex relationship may be more empathetic, particularly with reference to understanding the meaning of the loss of a breast.

Women who love and are sexual with other women have significant concerns about changes in the breast tissue. Address sexual concerns and how breast cancer and its therapy may affect sexual function. Lesbian sexuality has often been neglected in the medical publications and in the media. Approximately 3% to 5% of the female population is comprised of self-identified lesbians who enjoy sexual relationships with partners. Many are in long-term committed relationships that share social, financial, and child-rearing responsibilities.

According to the Lesbian Health Fund’s founder, Kate O’Hanlan, who is also a former president of the Gay and Lesbian Medical Association, there are many health care concerns that may negatively impact a healthy sexual life that lesbians should discuss with their healthcare providers. Some of these are shared with the general female population, including risks for breast cancer (some women over the age of 40 do not get regular mammograms, do not perform self breast examinations or receive clinical breast examinations), gynecological health care, osteoporosis, and domestic violence. Of particular concern to lesbians, issues related to depression, anxiety, and other psychiatric illnesses, due to possible chronic stress from homophobia, stress from disapproving family, and/or unfriendly work and social environments, are important to address. These issues can result in substance and alcohol abuse and excessive tobacco use. Obesity may also be a concern. Cardiovascular health care is critical and screenings for diabetes, high cholesterol, and high blood pressure should be done regularly, as well as improving overall diet and fitness.

Some medical illnesses or surgical procedures that impact the breasts may also adversely affect the sexual pleasure of lesbians who focus on breast caressing and stimulation for a large part of their sexual arousal. Those who have had surgical alteration or removal of this erotic area of their body may feel saddened by the loss of this sexual organ.

Clitoral arousal and stimulation may also be impacted by medications that blunt arousal (depressive medications). “Lesbian bed death” is a term that sex researcher Pepper Schwartz coined to describe diminished sexual passion or sexual activity in any long-term relationship, may also be a concern.

Term:

Homophobia – Range of negative attitudes and feelings towards homosexuality and people identified as gay or lesbian.

If the relationship is “solid” emotionally before a breast cancer diagnosis, it will persist after the treatment and recovery process.