beth israel deaconess medical center a harvard medical school teaching hospital

  • Contact BIDMC
  • Maps & Directions
  • Other Locations
  • Careers at BIDMC
  • Smaller Larger

Find a Doctor

Request an Appointment

Smaller Larger

The New Physical Normal

Posted 3/19/2015

Posted in

  This is going to be a superficial post. Now you have been warned. It's not that physical appearances are not important--they are--but we all surely know that health is more important. If you want to skip my musings and go directly to the link at the end, you will find a terrific essay by Heather Millar about this topic. Her words have stimulated me to think a bit about this.

  Here is the hard truth: Physically, we are just not the same after cancer. We can exercise and diet and use expensive make-up or even have "face work", but it is going to be different. Twice a month, I have a terrific support group for women who have completed treatment for breast cancer and are living with all the "Who am I now?" questions. Some of those questions surely are related to "Whose body is this?", and we talked a lot about these issues yesterday.

  Several women who were here have had mastectomies and reconstruction. There is a general sense that most women are ill prepared for the magnitude of this surgery and the difficult recovery. Of course it depends on what kind of reconstruction and whether there were complications and just how how one's body heals, but it is always very tough. In speaking honestly with each other, there was also a lot of conversation about how even the best reconstructed breast is not a natural one. Many types of breast reconstruction use tissue from other parts of the body, so, in addition to the changed breast, a woman is left with scars--often big ones--somewhere else. And, of course, if a woman has a mastectomy without reconstruction, the flat chest is a daily reminder of what has changed. To fully cover this particular topic, it should be said that many women who get by with a smaller surgery, lumpectomy or wide excision, and radiation find that their breast (s) post treatment is changed, too.

  And the surgical changes are only one obvious part of the different body. Other kinds of cancer bring other kinds of surgery. Surely losing a limb or an eye or part of a jaw or having a colostomy bag is a very big deal. People adapt, and we almost always have the perspective that "alive is better", but this can be very hard to put it mildly.

  What else is different? Let's go head to toe: hair. After chemotherapy, is does grow back, but it may never be quite the same as what was there before. And, during the prolonged growing in period, it can be really different. I clearly remember looking in the mirror and thinking I must be in the Witness Protection Program; old friends sometimes didn't recognize me. It may come in white or gray; that can be fixed if you want. It may be thinner or curlier (likely for a while) or a very different texture. I have known a few women who were delighted by their post chemo hair, felt that it was an improvement. Note that it may take several years for your hair to stop changing and be what it will be. Most of us just keep looking for a good hairdresser. And people who have brain radiation likely never have hair again in the area that was radiated. They are looking for a really good hairdresser.

  Other hair changes include eye brows and lashes. They are often thinner and occasionally thicker and wilder. For some of us, they may seem almost absent. I have known women who resorted to tattoos for eyebrows, and spent huge amounts of money hoping that a mascara exists that makes short and thin lashes look good (if you have found it, please let us know in the "comment" section). Other body hair is often different, too. Without being too graphic, I remember one woman whose husband began to call her "Barbara" after some intimate body hair grew back (think about it). For others, it may look as though you have had a permanant bikini wax. Arm pit hair may never return if that area has been radiation.

  Skin tone and general complexion are often different. Lines and wrinkles seem to abound where they did not previously exist. Again, you can spend vast amounts of money on beauty products (and, again, please share your successful finds), but nothing will bring back the pre-chemo skin. Women who experience an early menopause due to surgery or drugs have more years without estrogen's boost to skin. Most of us just think we look older, and older by many more years than have elapsed since cancer. It is never helpful to compare ourselves to our friends who have not had cancer. Your beauty peer group has changed.

  And another biggie: weight. I am not going to spend much time on this one, as we can all write the sentences. Weight gain is often caused by medications and/or menopause--and those pounds are harder to lose. Do you remember when you were 20 and could just skip dessert for a few nights and drop five pounds? And what happened to our waists?

  Here is my personal bottom line: I am grateful to be alive, and I am determined to age gracefully. And, as my mother always told me: "Legs last."

 Heather has more to say:

Making Peace with the Mirror
By Heather Millar

That picture of me that you see just to the right of this post was taken five years ago – just before I was
diagnosed with cancer. I’ve put off replacing it with something more current.
That’s how I see myself in my mind’s eye. But the truth is, I don’t look quite as good these days. My face is
rounder, my hair cut a bit shorter in a chin-length bob, and my eyelashes are almost invisible.
I know that I don’t have it nearly so rough as most of you reading this blog: I’m almost exactly four years
post-chemo. My hair has returned to normal and I have eyebrows again. My fingernails are no longer
weak and ripply. My complexion is reasonably okay.
But my eyelashes have never grown back quite right. I don’t know why I even bother trying to make them
visible with mascara. And, worse, the combination of steroids plus estrogen-blocking drugs has made me
pack on about 30 pounds since that picture was taken.
I’ve done what my docs have recommended: I try to minimize carbs. I eat lots of whole grains and veggies.
I try to limit sugar (really! I don’t eat dessert or candy). I only drink on the weekends, and not heavily even
then. I hike or cycle or run at least five days a week. I don’t just play at it: I get my heart rate up.
And still the pounds pack on. Ever so slowly. But still. I’ve got strong muscles under a sheath of fat.


Add your comment



  • Claire Blum said:
    3/21/2015 10:58 AM

    Amen -- and hours spent looking for all-cotton or wick-away clothing, hefting weights, and rubbing in oils like the tin man in Wizard of Oz.