53 E-mail: Anger and Depression

February 4, 2007

A lot of things have happened that I feel compelled to share. I can only fit so much into one evening’s e-mail message so here is the first of a handful of topics. I’m doing well these days, but I have found that the journey didn’t exactly end with the last dose of radiation.

2006 drew to a close and I found myself reflecting upon the year. As my personal experience with breast cancer so far has been encapsulated within that calendar year, I kind of associated the close of 2006 with the close of the breast cancer book for me. I firmly stepped from Patient to Survivor and finally felt that I deserved the Survivor label.

The chapter may have ended but the book isn’t really finished.

The months go on and slowly I am spending fewer moments looking over my shoulder, but the specter of breast cancer always looms in my memory. I’m still adjusting to Life After Cancer and I’m still struggling to come to terms with it. The biggest emotional surprise in late 2006 was my anger.

Depression is perfectly normal for cancer patients during and after treatment. Looking back over I would describe treatment as a deeply traumatic experience. Post traumatic stress symptoms are normal for cancer survivors and the funny thing about knowing stuff like this up front is that the knowledge doesn’t stop the roller coaster. It just gives you a point of reference as you ride.

So I talked to the therapist I had started seeing to help me cope with life after cancer and the depression would lift for a while.

Let me back up. You know that feeling when you’re really scared, like when somebody manages to sneak up on you and then touches your shoulder and you just about jump out of your skin, and then fear is immediately replaced with anger that you were made afraid? Well that’s something like the anger I experienced during the weeks between chemo and radiation. The diagnosis and chemo had made me afraid. Then I had time to relax and reflect, and suddenly I was angry that cancer had invaded my body and invaded my life. Our lives. I resented that it took away from the joy of having a newborn baby and that I missed so many moments with my son because I was in treatment or recovering from treatment. I don’t know if I did that topic justice when I was writing the blow by blow essays, but the chemotherapy days were grueling in part because they cost me precious Mommy moments. I had to rely so heavily on my husband and other people to take care of Kelric for me so I could rest or go to medical appointments that I felt disconnected from my own child for the longest time. It felt like a major accomplishment on weekends when it was just me, Guy, and Kelric in the house and I would correctly interpret a cry or a wail. It was a euphoric high to comfort Kelric and have him respond.

Guy assures me that the difficulties I experienced, such as feelings of loss when the latest Kelric caregiver would tell me about something new he did that she saw and I did not, are feelings he shared as well. He believes that all fathers who work full time and only get to bond with their babies on nights and weekends are equally at a loss and equally anxious about learning how to care for this new little life without doing something stupid and accidentally causing harm. I suppose then that my cancer experience helped me share yet another perspective I ordinarily would not have known. Lucky me. I still say that cancer was a thief and it robbed me of many things, including time I should have had with my one and only baby. Only now with more time between the present and the days of chemo has the bitterness over that loss begun to lose its sting.

When the radiation period ended I experienced the anger that comes as a normal stage of grieving. It’s that separation phase where you’re learning to let go of something or someone.

That anger morphed into something else.

Just as I would start to think I did not need therapy anymore and I was doing fine, I would find myself horribly depressed one day or extraordinarily angry and I could not understand why. I would talk about it to my therapist, feel better, and then start thinking over the next week that everything was fine and I did not need therapy anymore. It became a new roller coaster and I struggled to understand the cause. It is not like me to feel deeply depressed or to feel even moderately depressed for several days or weeks in a row. It is not like me to feel my temper flare in traffic unless I’m hungry, tired, or both. I found myself extremely annoyed or frustrated or downright mad at people for minor things – and knowing the incidents were minor in no way reduced the anger. It was out of proportion and I felt a little out of control of myself. Since my body’s reactions to chemo were out of my control this push-me-pull-me dance I had begun with depression and anger also scared me. How could I find a way to just be me again?

Then one fortunate Thursday night our friend Diana Vicars called. She’s the best hair stylist I’ve ever known and her friendship, kindness and compassion made a significant contribution to my being able to “hang in there” during treatment. Diana reminded me that the People’s Pharmacy near 38th and Lamar is a good place for cancer survivors to get advice about nutritional supplements during and after treatment.

So Diana calls and I tell her about my experience that afternoon of staring at the stapler on my desk and feeling a strong urge to hurl it at the wall as hard as I could. I was so angry over some trivial incident that hurling an object that could hurt someone seemed like counter pressure to relieve the agony. It’s like when you have a sinus infection and there’s pressure behind your sinus cavities, and if you press your fingers in key areas it actually makes you feel better for just a little bit. The only reason I didn’t act upon my impulse was because I didn’t think I could pass off a stapler-sized hole in the wall as something that could happen from accidentally dropping the stapler.

I’ve confessed that memory to a few other people since then because it was such a strong low point for me. I’m glad I didn’t act upon it, and it’s not like me at all to have violent mental images. Diana gave me advice which I followed and it has made a world of difference.

Take B vitamins.

From Diana’s advice and the research I did afterwards I learned that the liver stored B vitamins. The liver filters poisons out of your bloodstream. Where are chemotherapy drugs dumped? Uh, into the bloodstream. That’s what the port is all about – to help the poisons reach your heart as quickly as possible where they are pumped to your entire system via the blood. So (now we are getting into my personal theory) the liver must go nuts processing a ton of poison it would normally try to filter out. I’ll bet if I ask my oncologist he will confirm that chemotherapy drugs are deliberately dosed to be toxic enough to get past the liver so that it does the most good in terms of killing cancer cells.

B vitamins, for those of your who are like me and can’t spout the uses of most vitamins off the top of your head, are a series of 8 vitamins scientists thought at first were a single vitamins and then realized later were a family of vitamins. They have names like Riboflavin, Niacin, and Folic Acid. They have numbers like B1, B2, B9, and B12. Some of the B vitamins help with little things like depression and anger. Actually, let’s say that a more scientific way. If one’s body has a deficiency of B vitamins, one may experience symptoms such as depression and anger.

Another side step: one friend pointed out that anger is depression turned inward. I suppose I probably felt internal as well as external anger, then. At least my mind was an equal opportunity depressionist.

Other things that can go wrong when your body has insufficient quantities of B vitamins can include heart palpitations and fuzzy thinking. I was really scared by an abundance of heart palpitations at one point. Remember I went to the emergency room over it because I was scared I was having heart problems? They found nothing wrong and sent me home. Memory loss issues and the inability to think clearly also seem to be linked to lack of one of the B vitamins.

Let’s think about this. The liver struggles to cope with excess poisons. The liver stores B vitamins. The liver gets damaged from chemotherapy so it no longer does as good a job as it used to. Depression sets in. Maybe depression is linked to liver damage linked to B vitamin deficiencies?

I started taking a daily B vitamin pill. I looked for something that focused on Bs and no other vitamins. I also started taking Sam-e every day because Sam-e also helps ease depression, increases clarity of thinking, and incidentally it can help repair liver damage.

It was a night and day improvement.

I felt like myself again! Still do, because I’m still taking my supplements. I no longer need therapy. I’m no longer depressed. I’m no longer angry (unless another driver does something really stupid and then I get over it in about 30 seconds).

At one point I ran out of the B vitamins the lead pharmacist recommended I take when I was in chemo. I took the pills for a while, but they were big horse pills and smelled bad. Being half nauseated all the time, I found it too difficult to swallow the nasty pills and not have them come back up so I quit taking them. So in December I took the remaining vitamins each day until the bottle was gone. I purchased a different brand of B vitamin complex and couldn’t remember where I had put the bottle. It took me two days to run across it in the kitchen in the cabinet with all the hot tea bags. Why was it there? Who knows. Maybe a quick clean up because company came over – I don’t know. What I do know is that in those two days I went back to feeling angry and depressed and I could not understand why I felt so rotten again until I realized that I had quit taking my daily dose of Bs. I found the bottle, took my new, smaller (but still stinky) horse pills and felt like myself again. This is not a placebo effect for me. I believe it is a real, chemical difference.

How nice to have found something so effective so quickly! I’m back to joking with people at work. I know not to take every little thing personally, and I only bite my husband’s head off when I’m too tired or too hungry. That’s the way it should be.

Angela

P.S. Never ever put it in writing that you have experienced depression if an insurance company asks. That is a weapon they will club you over the head with about denying you new coverage. Yes this comes from personal experience backed up by the wisdom of an insurance agent and her personal experience. No, it isn’t about my cancer and isn’t affecting my life now.

Previous - 52 E-mail: Race for the Cure (Nov 2006)
Next - 54 E-mail: one year of survivorship