When we break the news to women that they have breast cancer, it is one of the most difficult conversations to have; and even though we’ve had these talks countless times, they never get easier. Our patients are anxious and worried; the information we are giving them will change their life forever. As surgeons, we have the skills to heal them physically, but emotional healing is another story.
During The Breast of Everything podcast, Dr. Joe Kort, a psychotherapist and director of The Center for Relationship and Sexual Health in Royal Oak, Michigan, shares his insights about breast cancer and grief, and how to help women effectively deal emotionally with their diagnosis.
Allow yourself some time to feel angry and upset. When you express these feelings – verbally or in writing – it tends to help you let go of them.
For spouses, they also are dealing with the emotional toll of your diagnosis. They feel helpless; allow them to be helpful. Even though cancer patients often are not willing to ask for help and want to remain in charge, remember that your partner wants to help you. Let him.
What about the kids? Do you tell them you have cancer? How do you tell them? What is the best approach? First, don’t lie to them. Kids know. They will sense something is wrong. Tell them the truth but in terms understandable for their age. They may blame themselves, thinking they were bad and that is why you got cancer. Reassure them. Be real, provide the facts, and keep it as positive as possible. Listen to them and answer their questions the best way you can.
Breast cancer patients not only grieve over their diagnosis, but also over how their cancer may change their appearance. They may never look or feel the same way again, they believe. Their breasts are part of their sexuality and they worry about losing that. How will their spouse react? Will it affect their relationship?
Breast cancer can be a growth experience for couples depending how each person is coping with the diagnosis.
Grief can take unexpected forms. Expect the unexpected. Expect guilt, expect self-blame, expect blaming others. Women are faced with a whole new set of issues they never have encountered before in their life.
During this time, find ways to help yourself relax, try to stay as active as you can, keep your life as routine as you can, try to find activities that bring you joy, and control what you can control and let go of what you cannot control. It is important to know there is help and support if you need it. Talk with your physician and seek counseling if you feel you need additional help.
When we break the news to women that they have breast cancer, it is one of the most difficult conversations to have; and even though we’ve had these talks countless times, they never get easier. Our patients are anxious and worried; the information we are giving them will change their life forever. As surgeons, we have the skills to heal them physically, but emotional healing is another story.
During The Breast of Everything podcast, Dr. Joe Kort, a psychotherapist and director of The Center for Relationship and Sexual Health in Royal Oak, Michigan, shares his insights about breast cancer and grief, and how to help women effectively deal emotionally with their diagnosis.
Allow yourself some time to feel angry and upset. When you express these feelings – verbally or in writing – it tends to help you let go of them.
For spouses, they also are dealing with the emotional toll of your diagnosis. They feel helpless; allow them to be helpful. Even though cancer patients often are not willing to ask for help and want to remain in charge, remember that your partner wants to help you. Let him.
What about the kids? Do you tell them you have cancer? How do you tell them? What is the best approach? First, don’t lie to them. Kids know. They will sense something is wrong. Tell them the truth but in terms understandable for their age. They may blame themselves, thinking they were bad and that is why you got cancer. Reassure them. Be real, provide the facts, and keep it as positive as possible. Listen to them and answer their questions the best way you can.
Breast cancer patients not only grieve over their diagnosis, but also over how their cancer may change their appearance. They may never look or feel the same way again, they believe. Their breasts are part of their sexuality and they worry about losing that. How will their spouse react? Will it affect their relationship?
Breast cancer can be a growth experience for couples depending how each person is coping with the diagnosis.
Grief can take unexpected forms. Expect the unexpected. Expect guilt, expect self-blame, expect blaming others. Women are faced with a whole new set of issues they never have encountered before in their life.
During this time, find ways to help yourself relax, try to stay as active as you can, keep your life as routine as you can, try to find activities that bring you joy, and control what you can control and let go of what you cannot control. It is important to know there is help and support if you need it. Talk with your physician and seek counseling if you feel you need additional help.
Unknown Speaker 0:01
Welcome to the breast of everything podcast your trusted resource for breast health information support and encouragement. Your host today is Dr. Eric brown of comprehensive breast care. Welcome.
Unknown Speaker 0:13
Welcome to the breast of everything podcast. This is Dr. Eric brown your host today. Cancer doesn't just invade your body, it invades your entire life. When we break the news to patients or see patients in the office with a diagnosis of breast cancer, we know that it's a life changing event for the patient, their spouse in their family. The conversation is never easy. And we have a lot of information that we need to get across to the patient in terms of their treatment, what to expect what their options are. But we always keep in the back of our mind the emotional toll that it's taking on them. I'm very excited today to have with us, psychotherapist, Dr. Joe court from the Center for relationship and sexual health in Royal Oak, Michigan. Dr. cord is the clinical director and founder of the Center for relationship and sexual health, and the CO director of modern sex therapy Institute. Throughout his 35 years of private practice, Joe has successfully helped hundreds of individuals and couples improve their lives and strengthen their relationships. He also works with patients who suffer from anxiety, trauma and depression, and provides grief and bereavement counseling. Welcome, Joe, I'm excited to have you today.
Unknown Speaker 1:34
I'm glad to be here. Thank you on such an important topic. Really?
Unknown Speaker 1:39
Yeah, it really is. And it's something as we were talking before we began recording, you know, it's not something that has a lot of attention to the medical community, and that is the oncologic medical community, we are giving information that will change somebody's life forever. And that doesn't just end with treatment and doesn't just end with their next mammogram, it goes on and on and on. Tell me a little bit about some of the patients that you've seen in the past with cancer diagnosis or your experience with the trauma of any diagnosis, I guess, for that matter.
Unknown Speaker 2:20
Well, I mean, especially this one on so many levels, because you know, we deal with relationships, we deal with sexual health. And it affects both for women because they start to think about obviously, their health, but then also their sex appeal to a partner and, you know, their breasts have been a part of their sexuality. And so this is something that's going to change their that part of their life, too. So it's important to have both conversations when they're in therapy.
Unknown Speaker 2:47
Yeah, there's, there's no question. And throughout my career, which goes back into the early 90s, the the perspective on what surgery and breast cancer is in what it means has completely changed. And to that, I mean, back in those earlier days, it was cancer. And really, no matter how it looked, it was a cancer, we had to get the cancer out. And the look was far down on the list of priorities. Today, it's actually much different, and with new surgical techniques that we have the look is very important and should be, of course, it's not the top priority, but it should be important. We have a number of new technologies and techniques in even something as simple as lumpectomies to provide good symmetry and excellent cosmesis. But again, that sexuality concern that women have is is a real one. And it's not only the woman, correct?
Unknown Speaker 3:52
Right? No, no, of course not. No, the partners are the male partners are very much the same. And they don't want to hurt her feelings, but then they're having their own struggles around it. And yeah, I think that's really good information for people to have that it has changed. Actually, I was at a party a couple of years ago, and this woman had had breast cancer, and she had had them both removed, plus her nipple. And she talked about how she had them tattooed back on and that you couldn't tell. And it was a very appropriate party. This is gonna sound really weird, but she showed us and I was so impressed and shocked and how you could not even tell that that was a tattoo. It looked like it was real.
Unknown Speaker 4:29
Yeah, some of the plastic surgeons have gotten pretty fancy in their tattoo techniques and even content to the nipple and a 3d appearance. So it looks almost like there's a projection.
Unknown Speaker 4:40
Yes. She was very proud of that.
Unknown Speaker 4:43
Yeah, and it's, you know, it's definitely something that has come a long way. Now, many patients are eligible for what's called a nipple sparing mastectomy. So when they choose a mastectomy as their option we can actually preserve the nipple and Ariel or Complex. So in essence, it looks like they just had a breast augmentation, despite the fact that they've had their breasts removed. Oh, it's, it's always striking to me, however, that many ask the question, will there be sensation, which again, goes back to our point of it does have meaning and sensation in the nipple and areola complex, which unfortunately, for the most part does not persist after the surgery is a concern. It's a concern for women is obviously especially younger women. But, you know, we don't define young anymore by a birthday. It's it's how active you are. And as we know, people in their 70s are still sexually active.
Unknown Speaker 5:40
Yes, yeah. No, that's really good to know. And I think it's great. They ask you that because a lot of people are too afraid to talk to doctors about that kind of a thing. And they shouldn't be and doctors should be able to answer that and sounds like you are.
Unknown Speaker 5:52
Yeah. And there's actually some techniques that are on the very, very early stages, where some of the nerve preservation in and around the nipple and areola are going to become potentials for us to maintain some of that sensitivity.
Unknown Speaker 6:07
Sure. And you know, we're talking sexually, but you know, just about physical attractiveness and, and then how are they going to make up for it if they, some people just accept it, I've had clients, I've had several, I just think there's such strong women where they're like, Okay, I'm going to do this, it's all going to go, and I'm going to make the best of it, and I'm going to get stronger around it, they start bodybuilding, they start playing basketball, they start taking care of their health in a way that they never did before. And it can be a total game changer for them in a positive way.
Unknown Speaker 6:36
Yeah, definitely. I know that I've seen in my career that patients and obviously most of our patients are women, though there are some men, they really do kind of find an inner strength, don't they? I mean, they really do become a different person on the other side of this.
Unknown Speaker 6:53
Yes, yes, they do. And I don't mean at all to bypass the trauma and the horror, and you know, we see all of that in our office. And, you know, the scare. I mean, women are afraid of this anyways, you know, every time a woman goes to get a breast exam, she's worried about it. And then when the doctor comes in and says, yep, this is it. It's a it's a horror movie for her. Of course it is.
Unknown Speaker 7:14
Now, we, back in my early days in psychology, I heard about the stages of grief. Do you think something like that exists for people that have this type of a diagnosis? Is there a grieving period for though
Unknown Speaker 7:27
100%? The denial, the anger? I don't know that, you know, the stages are in an order, but we always say the order isn't really real. It's it's just these things happen. The denial, the bargaining, you know, acceptance, anger, depression, you know, of course, that's when people come to us as the depression is they can't get pet they can't snap out of it. And nor should they try to do that on their own. This is something that's a teamwork effort.
Unknown Speaker 7:53
Yeah, definitely. And I know myself, that we have patients, especially those that have had a little bit more advanced, or I hate to classify it as serious, because every cancer is serious. But those that have had a big time, traumatic experience, where they've needed chemotherapy, they might have needed radiation, so kind of everything. And when they come out on the other side, many just to not feel like they can get back to themselves. They just feel like this sense of, of doom. Is there a depressive risk, long term and patients with the diagnosis, Joe?
Unknown Speaker 8:30
Yeah, so what ends up happening is, you know, we all get depressed. I mean, days happen. Things happen in our life, and we get depressed, but then you can move into depression. And now that's different, right? So that's like, I can't get out of bed. I'm not taking care of my hygiene. You know, I'm not doing enjoying the activities I used to you enjoy. Maybe I even feel suicidal, even if I'm not actively and, or intentionally, but maybe I'm feeling like, I would be really good if I didn't wake up. And that's not an easy thing to snap out of. We always tell people, it's better to get treatment or intervention when you're depressed. Because when you're in depression, it's a lot harder to come out of it's not impossible, but it's harder.
Unknown Speaker 9:12
Yeah, and we can really feel for for women, especially those that are undergoing chemotherapy, because just the therapy itself, as much as it's improved in terms of its tolerability, it still is a difficult five to six months of their lives. So being depressed, on top of not feeling well on top of never really feeling like you're ever going to feel well again, what are things that women can do or spouses can do during this time, this treatment time because patients really need some guidance as to how they can best focus their energy to try to stay out of depression.
Unknown Speaker 9:55
Yeah, so um, really, it's, it's getting help for themselves. Even you know, like, really being there for her and being supportive as much as you can be, but you got, it's really, this is not just happening to her, it's happening to them as a couple, it may even be happening to them as a family. And sometimes family intervention is really important. Because everybody, you know, people don't understand when somebody is going through a trauma, there's something called vicarious trauma. And that is that you end up having secondary trauma by just witnessing somebody you love go through this horrible thing. You know, I know it sounds weird as a therapist saying to get therapy, because that's my job. But where else can you go? You can get support group, you don't guild This house is great locally here, that, and it's a great support support place. But sometimes, it's better to get one on one kind of support. Yeah, I
Unknown Speaker 10:49
agree. I do think that support groups have value to them. But they can also be a little bit scary for patients, because you know, no two fingerprints are the same. And no two cancers are the same. So you get around with the group, where everybody's cancers a little different, their treatments a little bit different. And you kind of look across the room and wonder why they're doing something that you're not. So that is definitely can be very, very scary. So individual counseling, I think, I think is a really good idea.
Unknown Speaker 11:17
That's a good point, because you start comparing, and and then some of my clients have said, you know, just being around cancer all the time is very depressing in and of itself. So it's just nice to come to a regular clinic where they're not people aren't being seen just for one thing. Right, right, exactly.
Unknown Speaker 11:31
Now, you touched on something else that I'd like to take a second or two on. And it's a very, very common question, especially with our younger patients, the family, how do you talk to your kids? We're not talking about your 25 year old son, we're talking about kids that are in that nine to 12 year range? What What do you think is the best approach that that patients and families can take in addressing this cancer diagnosis with their kids? Because obviously, things are gonna change? Yeah.
Unknown Speaker 12:04
I always tell people, it's not good to lie. Kids. No, I know, people don't think think kids know, they know whether they know, you know, in their frontal cortex, they probably don't, but they, they have a sensibility that something's wrong. And I think it's important for the parents to be able to say something is wrong, but you don't have to fix this. I'm going to the doctor, I'm taking care of this. And I'm in charge of, of making sure I'm okay. You can talk to me, I want to be here for you, too. You can be supportive to me, but you don't have to feel like you have to fix me. That's the number one thing because kids think, what am I doing? And what could I do to make things better for my parent? Yeah,
Unknown Speaker 12:44
I definitely, definitely see that. And I try to give similar advice to patients. Because if you lie, then they kids have this sense about them to know when something's not quite right. And if you don't tell them, which there are some patients that would prefer to just kind of keep this under wraps, once they find out, they always think it's worse, because you didn't tell them
Unknown Speaker 13:09
absolutely 100%. And you know, just being as real as you can without scaring them. But they might be frightened, and it's okay, if they're frightened. This is frightening for everybody. But the most important thing is that they don't have some kind of magical thinking that there's something that they can do to make her better take it away, and just normal for a kid to feel that way. But but they need to feel like the adults are taking care of
Unknown Speaker 13:35
it. Yeah, that's great, great advice. One of the other issues that we deal with a lot with patients are those that have a cancer that maybe has been there for a little while. So I have a lump and didn't really get addressed as quickly as maybe I should have saw the patient start to feel guilty themselves for not having done that. How do you think it's best to address that sense of guilt that many patients have if they waited a while before they got their diagnosis? Because obviously it doesn't change anything and it still needs to be treated?
Unknown Speaker 14:13
No, you're right. I mean, they end up feeling like that. remorse How could I that I did this to myself, I shouldn't all this, you know, like people do this when people die even you know, like, I should have been a better person, a better daughter better sibling, I could have done this. I could have done that. Rather than just recognizing you did the best you could. And you know, it's not your fault. This happened. You did? How you How could you have known?
Unknown Speaker 14:35
Right, right. Yeah, we we see so much on the psychological side of things. A lot of times my partner and I, we think that we have some little bit of therapist in us, because the treatment sometimes becomes almost secondary to some of the side effects of treatments and how that affects somebody's personality, their sexual reality, their intimacy, the relationship with their spouse. One of the best examples we have is medications that some women take after they finished a lot of their treatment, which is an estrogen blocker. So an estrogen blocker lowers somebodies estrogen, and we use those medications for at least five years. Well, libido is affected by lowering your estrogen vegetal dryness with lowering your estrogen. So we're dealing with patients that not only have a cancer that needs to be treated, but some of the side effects of the things that we offer are not without their own psychological issues to them.
Unknown Speaker 15:41
Right? And then these couples come to me and or to a sex therapist, and they basically say, what should we do? And I always tell them, I am not at liberty to tell you, I mean, you're not going to get a doctor, drug court response is not the right response for you, as a couple, the two of you have to talk to each other, until you come up with your own answer. And you may have an answer that nobody on this planet has even thought of yet. But let the two of you come to your own place around it, which is really hard.
Unknown Speaker 16:08
Yeah, it definitely is. Because we do see some patients that will actually abandon their therapy, because they're so affected in a negative way, because of the side effects of the therapy. And we always circle back to the original consultation we have with patients where I say, but if I would have told you back then that I have a spill that could lower the chance of the cancer spreading. All you got to do is take it once a day, you would have jumped at it. But now here we are in the midst of it. And now some of these other issues that have come up. We're kind of giving up before we've given it a chance.
Unknown Speaker 16:42
Yeah, it's such a feeling of helplessness, which adds to the depression, because that's part of depression is helplessness. So she feels that way her family feels that way. I'm sure you feel that way. I mean, just even I feel that way as the therapist, it's normal. And, you know, people want to like Eclipse those feelings or run from those feelings or hide from those feelings. I get it. But it's not going to be helpful. It's really embracing those feelings, not not like, well, I can't do anything about it. So I'm going to just surrender to everything, but to just allow yourself to feel badly about it.
Unknown Speaker 17:12
Yeah, I think that's important. I think that it, it's okay to be upset, it's okay to be angry. And we have to, we can't deny these things. Because I think I'm not a therapist. But I imagine that when you push those symptoms to the side, they're going to bubble up in some other way. And we know that in the relationships that women have with their husbands as they're going through these treatments, because that's their their number one supporter, but it is really trying and taxing on a relationship, having to watch your spouse who you love, go through something like this and talk about helpless, the spouse is generally helpless. Any advice you have for specifically the significant other, whether it's a spouse, whether it's a child taking care of an elderly parent, and how they can best put themselves in position to be helpful
Unknown Speaker 18:10
to ask for what she might need, and to really be willing, because sometimes people want to fight her. No, I think you need this. Let her tell you what she needs. You can anticipate her needs. And you can say what about this? What about that, but really let her be in charge of what she would need from you, and really get support for yourself. And it doesn't have to be therapy, it can be going to your friends going to family going to each other in the family and being there for each other on such a difficult time.
Unknown Speaker 18:41
And you know, what really adds to the stress that women and families feel are indeed those friends. Not that the friends are doing it intentionally. But as I'm sure you can imagine, everybody you know, knows somebody who knew somebody that had the same thing. And here's what they did. So now you're in midst of a diagnosis, you're planning out your treatment, and you're getting advice from every Tom, Dick and Harry out there. As, as the spouse you kind of have to be protective of that, I would imagine.
Unknown Speaker 19:13
Yeah, very much. So you're right about that. Because then people want to tell you, here's what worked for me, why aren't you doing this? Why aren't you doing that? And that just adds to the pressure of what you're trying to get through.
Unknown Speaker 19:24
I think a lot of the ramifications of what we do, probably has a lot to do with how we as physicians present things. There was just an article that was published, actually this month in the Journal of Clinical Oncology, talking about women who choose to do a double mastectomy. So real brief. When somebody has cancer in one breast doing a double mastectomy does not improve the outcome on any level. It doesn't make you live any longer. It doesn't reduce the chance of the cancer coming back. But we do this quite frequently because of the fear that it implies. And this article basically said, we, as physicians need to figure better ways to present the risks, rather than the risk of something bad happening, maybe talk about the risk of nothing bad happening, because that number is a lot bigger. But when people hear the risk of recurrence is 10%, they want to do a double mastectomy, rather than the risk of it not coming back as 90%. Not presenting it as the 10%. Bad, but only of the good. Any advice that you have for, for us for myself or my partners, for others in the field, is how to deal with a lot of these anxieties that patients bring to the table.
Unknown Speaker 20:49
Wow, that's such a good question. First of all, I did not know that I've Oh, I remember hearing that if you get both breasts removed, then you're at less risk. But that's you're saying that's not true. That's not true. Now. Yeah, that's new for me to hear. I'm probably new for them to hear. And I mean, I feel like this, I feel like the best thing they could get from you is you being real, you've been honest. And just saying, and just letting them know that you're doing, you're learning the best you can you have the knowledge that you have, and having a human experience with them, I think is most important.
Unknown Speaker 21:21
Yeah, I definitely agree. And I think that having a connection and and what we're trying to establish in our practice as a connection with somebody like yourself, because I know myself, I've been doing this a long time, and I'm guilty of not having patients seek out some counseling sooner. I think that that should be almost along the lines of when is the time to check somebody's blood count. If you start to see signs, I think I need to do a better job at saying, Hey, I think we need to have you talk to somebody about this, because this goes on forever that cancer diagnosis is made. And like I said, it's life changing.
Unknown Speaker 22:00
It's life changing. And I'd I agree with you, because I think a lot of doctors don't see the value in the therapy for the client and don't understand it. And then the idea, and it sounds like you at least have some sensibility about the sexuality part. And a lot of doctors don't, and then they miss the boat on that for her. And then she feels either embarrassed to tell you or sometimes a lot of women feel like this is the end of their sex lives, you know that their husbands are their future partners, whomever they are, are never going to see them as sexual beings.
Unknown Speaker 22:29
Yeah, I totally agree. And I mean, as a male in this profession, it's, it's a challenge for me, because talking sexuality with female patients is a little awkward. And so I do what most men do, I just ignore it. And I don't talk about it, which is not necessarily a good thing, either. So, you know, we have in our practice, now we have some of our long term survivorship patients are seen by one of our PhDs, and she's well versed in some of the sexuality issues, because these are long term when patients are on some of the medications that I mentioned before.
Unknown Speaker 23:08
Yeah, that makes sense.
Unknown Speaker 23:10
So before we wrap this up any other messages that you feel might be helpful for patients, kind of maybe a little bit about what you guys do in your practice, and, you know, what, what support and when and how people can reach out to you.
Unknown Speaker 23:29
I just feel like people should know that if you go to a therapist, or you come to somebody in our practice, or whatever, you're, we're going to take you where you're at, you know, a lot of people get afraid that we're going to, you know, get you stuck in your past, and, you know, we're only talking about childhood, or we're gonna try to go in a direction that you don't want to go in. That's not a good therapist, there might be as a therapist, we might probe those areas, we might, you know, enquire and get you to think about those areas. But a good therapist is going to listen to what you we, where you're at what your needs are, and then follow that lead. you've hired us to help us give you other lanes to follow. But if you say you know, that's not my lane, right now, I'm here, we're going to help you there. However, if it's about depression, and you can't get out of it, then we're going to probably lean on you a little more harshly on getting extra help. Maybe it's psychiatric care, so that you can have medication, maybe it's yoga, maybe it's whatever it needs to be, so that you can not have to live in such a dark place.
Unknown Speaker 24:29
Great wonder wonderful information. Joe, thank you so much. I think this has been really interesting and kind of just a tip of the iceberg in terms of things that we as physicians need to do better. And, you know, it we're, we're very good at curing breast cancer, but we have to remember that there are consequences and friendly fire, if you will, the emotional damage that this diagnosis can do is something that we We need to continue to strive to address I think going forward. Yes,
Unknown Speaker 25:05
I agree. And thank you for having me on to talk about something. It's it's sacred. You know, I think about the men I treat when they have erectile disorder or erectile problems. And those those start happening. You feel like less of a man. For women. They feel like less of a woman when this happens.
Unknown Speaker 25:20
Absolutely. Absolutely. Well, thank you, Joe. I really, really appreciate you spending a little bit of time with us. You have provided some excellent information. And I'm hopeful it'll help many if not just one person out there.
Unknown Speaker 25:33
All right. Thank you.
Unknown Speaker 25:35
Thank you for listening to the breast of everything. This is Dr. Eric Brown. And I've been I've had the pleasure of talking to Dr. Joe Cort. Please again, if there are any suggestions that you have as to a podcast topic, please we want to hear from you. Please send them along. You can send them to compress cared comm that co MP vi r e a s t ca r e.com. It's been fun. It's been very enlightening. Thanks again, Joe. I appreciate all of your time.
Unknown Speaker 26:08
Thanks for having me, Dr. Brown.
Unknown Speaker 26:10
You've been listening to the breast of everything podcast with your host and board certified breast surgeon, Dr. Eric brown of comprehensive breast care. If you have a subject you would like the surgeons to discuss, please email your suggestions online at comp breast care. com. That's co mp breastcare.com. The doctors want to hear from you. The views thoughts and opinions shared in this podcast are intended for general education and informational purposes only and should not be substituted for medical advice, treatment or care from your physician or healthcare provider. Always consult your healthcare provider first.
Transcribed by https://otter.ai