Posted by: drrozkaplan | December 19, 2009

Why Worry?

My Great Uncle Irving, a very depressed individual, is not remembered for much other than his depression.  The quote his is ‘famous’ in the family for is “Don’t worry, nothing will be alright.”

It’s a real downer of a quote if you take it at face value, but when I dig deeper, I find it both amusing and insightful.  Amusing, because it’s the true ‘glass is half empty’, depressive view of the universe to decide ahead of time that nothing will be alright.  And insightful, because really, why worry?  Worrying doesn’t change outcomes.  It only wastes time and energy and makes us unhappy.

So when Fran asked me today, after telling me how much better she feels, and that she is in virtually no pain 1 day after surgery to remove her ovaries, whether she should worry about her remaining cancer risks, the obvious answer was ‘NO’. But that’s easy for me to say, and not so easy for her to do.

Let me recap.  This entry today is the last of 3 entries on Fran’s medical situation.  She has the BRCa2 gene mutation, which significantly raises her risk for developing ovarian and breast cancer, as well as increasing her risk for colon cancer and melanoma.  She made the decision to have her ovaries and fallopian tubes removed to obliterate that risk, and the surgery was performed yesterday.  She has decided against bilateral mastectomy, and is instead going to have intensified breast screening.  She will also undergo routine screening colonoscopies and skin surveys so that if she did develop any atypical lesions, she could have them promptly removed, hopefully before they became malignant.

The ovarian surgery went extremely well, and she is recovering quickly and uneventfully at home.  Her recent screenings have all been negative, but she is wondering about her future.  How much does she need to worry?

Anyone in her situation is going to worry to some extent.  We all worry from time to time.  Even those of us at average risk for cancer, heart disease, or any other condition sometimes worry about ourselves and whether some symptom we have could be ‘serious’.  Someone with an increased risk of a condition because of family history or exposure to some toxin or some chemical abnormality may be hypervigilant, looking for symptoms or signs of that disease.  There are times in our lives when we are more vulnerable to worry- when we have just found out about our risks, like Fran, is one of those times.  Another time is when we see someone else suffering an adverse event.  For instance, a relatively young man in our community died suddenly of a heart attack recently.  In the following week, I had a number of my male patients, all in their 40’s, come in with atypical chest pains or arm pains or shortness of breath, worrying about their hearts.  The death of their friend had triggered worry.  All the denial these men usually had about their daily aches and pains and twinges had gone underground.  Other things can push denial down- psychological traumas, fatigue, things we read or watch on TV, even.

The thing about denial is this.  Denial is a healthy defense mechanism that we all need so that we can get through each day without excessive worry.  It becomes unhealthy when we overuse it and we ignore true symptoms and warning signs of real disease.  In other words, we need a balance of healthy denial and reasonable caution.  When that balance is disrupted, we either worry excessively or we don’t take care of ourselves at all.

So what should Fran do instead of worrying?  First of all, she needs to have a plan of action.  And she does.  in conjunction with her primary care doctor, her genetic counselor, and her surgeon, she has a schedule of check-ups and screening tests that she will adhere to.  Her ovaries are out.  She will have breast MRI’s.  She will have colonoscopies, and she will have skin checks.  She will have regular breast and GYN checkups and a series of blood tests on a regular schedule to check for tumor markers.  By taking charge of the situation and taking action, she turns anxiety into action.

The other thing she should do, and is in the process of doing, is to process other feelings she may be having, and separate these feelings from the concerns of medical risk.  This kind of genetic risk comes with lots of emotional baggage, and she needs to unpack it.  For one thing, her mother passed this gene mutation to her.  Of course, her mother did this unknowingly and without intention.  Her mother didn’t even know she had the mutation until recently.  But Fran’s relationship with her mother has been fraught with difficulty for decades.  Her mother is dying of her own ovarian cancer, and it seems their differences cannot be resolved.  As Fran puts it , “It’s hard to feel that my mother has given me so little, and that THIS is one of the things she has given me, and yet still want to feel loving towards her as she dies.”

Fran also has two sisters, and neither of them has the BRCa2 gene mutation.  Only she has it.  By no means does she wish it on either of her sisters.  In fact, she knows that if one of the three of them had to have it, she was best equipped to deal with it.  Yet, she is also struck by the unfairness of it, and the aloneness she feels in it.

Finally, there is the concern she feels for her children.  They will not be tested until they are older, but it is hard to live with the uncertainty.  As all of us who are mothers know, we would do anything to spare our children pain, and yet in this case, there is nothing Fran can do.  DNA is DNA.  She has no power over it.

Fran is a strong woman and she will do everything she needs to.  She’ll also worry, but hopefully not too much.  With any luck her healthy denial will kick back in soon and she’ll get on with her life, thinking about this only when she goes in for her scheduled screening tests.

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Responses

  1. Enjoying tuning in to your continuing story about Fran. Wishing her the best, and you as you share these stories with us.


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