Sunday, August 28, 2011

Identity...and Self Image

I wrote recently about the impacts of cancer on Meagan's identity. There was a quote from the book I read ("About Alice") about how the biggest impact of cancer is that it "robs you of your identity". With Meagan, mostly of late that seems to have centered around her mind and her abilities (to write, to read). She's been upset about her newfound state and worried about whether it's permanent or the temporary side effects of medication and treatment. It's so hard to say. Lately she has been more forgetful, and having a harder time tracking and understanding what she reads, and stringing consecutive coherent thoughts together. It seems to be in there - at least on the verbal part - she knows what she wants to say, often, but it comes out a bit off.

She had her Gamma knife radiation treatment of the two brain tumors a bit over two weeks ago. She wasn't supposed to have any side effects - but she did. The speech issues seem to have resolved (the slurring and inability to come up with the words quickly). But her cognitive ability seems to have declined steadily since then. It could be there was additional swelling, and it is having an impact, and it does take 2-3 weeks before any swelling resolves (according to Kaplan and Vermeulen). This is even though she is on steroids (an anti-inflammatory drug). She's been concerned that the new treatment (The Tomo therapy of the spine) is reaching her brain - but I've told her that is not the case - it is very concentrated and has no effect outside the beam area. So all I can do right now is try to assure her that it is likely a side effect of the past treatment, in combination with the drugs, and that it will likely resolve. But it is distressing. Last night she decided she needed more laughter in her life and instead of trying very hard to read and comprehend the book (again, part of her identity) but failing, she was going to start watching more of the videos we've picked up for her (such as the "I Love Lucy" series). It is a concession to the cancer, one she is not making willingly or lightly. But the effort to reward ratio is out of whack with the reading, and given what she is experiencing overall - it is probably a wise concession, at least until her comprehension capabilities return.

The other part that has been really tough of late is around her appearance. Really two areas - her hair and her weight. The radiation treatment has caused a loss of hair on the back of her head, and she has short hair elsewhere. She got a good look at it last week and was not at all happy. So the wig came back on. The good news is her hairdresser friend, Alicia, came over last night and colored her hair - returning it to its "natural" color. It also helped to de-accentuate the difference in the back between her scalp and the hair. So I think she will feel better about going "au naturale" - because frankly she looks darn cute with her pixie cut in the front and sides, and when you see the bald areas in the back - which includes her horseshoe scar from the craniotomy - it makes one realize you are seeing a cancer survivor and she should be proud about that.

The weight is a more profound and troubling thing for her. She's up at least ten pounds, which for her historically is a lot - outside of pregnancies she has weighed about 103 pounds as long as I've known her. It is clearly related to the steroids. But that is not very consoling. Especially given she is likely to be on them forever, and maybe at larger doses over time. She has had to pick up some new clothing, looser tops and larger and stretchier bottoms. That is hard psychologically. She sees her closet with clothes she likes but cannot wear. She is worried about when the weather changes and she needs to get some cooler weather clothes and can't go to the "petite" section anymore. Her self-image has always been around cute, form fitting clothing. This is the woman who got "best dressed" in high school her senior year! So it's another aspect of the cancer that affects one's psyche. I can tell her, and I do, until the cows come home, that she looks great, cute, and no one will know or care. But she knows, and also sees how her face is rounder and that the medications have caused the back of her neck to be a bit fattier as well. Last night she looked at her ankles and commented on how much they have gotten fatter. That is quite an overstatement - maybe a tiny bit - but she had pretty darn bird like legs to begin with...

I guess the point is - there are changes happening to her body which are not within her control and she doesn't like them because they affect her appearance. That deviation from self-image is another insult from cancer - on top of the brain insults. The cumulative impact of all these things adds up - making her more fragile emotionally, So there is a lot of shoring up that a cabana boy has to do, along with all her friends.

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