Tag: depression

Breast Cancer and its Impact on Mental Health

Posted on by TriWellness in Blog, Uncategorized

Overview of Breast cancer

Breast cancer is a common cancer that impacts mostly women, but has a history of impacting 1% of men. Breast cancer is characterized by the formation of cancer cells in the breast tissue. Some common symptoms of breast cancer are lumps within the breast tissue, changes in size, shape, or appearance, changes in skin around the breast and nipple. Regular mammograms and self-examinations can assist in early detection and resulting better prognosis (Mayo Clinic, April 2022).

Breast surgeon, Dr. Judy C. Boughey, M.D. explains breast cancer.

Types of breast cancer

There are eight types of breast cancer.

Angiosarcoma

  • Cancer cells in the lining of blood vessels and lymph vessels
  • This a a rare cancer

Ductal carcinoma in situ (DCIS)

  • Abnormal cells in the milk duct
  • Earliest type of breast cancer that is noninvasive, and has a low risk of spreading

INFLAMMATORY BREAST CANCER

  • A type of breast cancer that develops rapidly
  • Symptoms include red, swollen, and tender breasts
  • This is a rare cancer

invasive lobular carcinoma

  • A cancer that begins at the lobules of the breast (the milk producing glands)
  • These cancer cells have the ability to spread to the lymph nodes and other areas of the body

Lobular carcinoma in situ (LCIS)

  • Abnormal cell formation in the lobules
  • Not a cancer, however individuals with this diagnosis have an increased risk of developing breast cancer
  • This is an uncommon condition

Male Breast Cancer

  • Cancerous cells in the male breast tissue
  • This is a rare condition

Paget’s Disease of the Breast

  • The disease starts at the nipple and extends outwards to areola
  • This condition is a rare type of cancer

Recurrent Breast Cancer

  • Breast cancer that reoccurs after treatment
  • Cancerous cells evade treatment

Risk Factors that impact Breast Cancer

The following are risk factors that can affect the development of breast cancer. However, having one or more of the following factors, does not necessarily imply that one will develop breast cancer.

  • Physically a female
  • Older in age
  • Personal or family history of breast cancer
  • Genes (BRCA1 & BRCA2 are known genes that increases the risk of cancer)
  • If you have been exposed to radiation
  • Obesity
  • Start of menstruation before 12 years old
  • Starting menopause at a later age
  • Having your first child after the age 30 or not having been pregnant
  • Postmenopausal hormone therapy
  • Drinking alcohol

Prevention and treatment

Breast cancer prevention involves lifestyle changes from diet and movement, and regular self exams and breast cancer screenings. In cases of high risk, your physician may recommend preventive medications or surgery.

Despite risks and prevention, sometimes an individual may still develop breast cancer. Due to intensive research, there are several treatments available.

Surgery

There are several different types of surgeries which is contingent on the severity of the breast cancer. Lumpectomy is utilized to remove the specific region around the tumor. A mastectomy is the removal of the entire breast, depending on the spread of the cancer it may involve the removal of both breasts. Another type of surgery involves the removal of certain lymph nodes; the amount of lymph nodes removed depends on the spread of the cancer. After the removal of the tissue, some patients may want to get a referral to a plastic surgeon for reconstructive surgery.

Radiation Therapy

Radiation therapy is another treatment strategy used to treat cancer. It involves x-ray or proton energy that targeted to the infected region. These beams of energy can be externally implemented or internally implemented, as in brachytherapy. Common side-effects of radiation therapy are fatigue, swollen or redness around the targeted region

Chemotherapy

Chemotherapy is a type of cancer treatment that involves utilizing medication to treat the cancerous cells. This treatment may be used prior to surgery to decrease the size of the tumors in the breast tissue. Other times, chemotherapy may be used post-surgery in high risk cases of the cancer returning. Chemotherapy is also used to treat cancer that has spread to other areas of the body. This treatment is known to have several side effects, from hair loss to vomiting, and a compromised immune system.

Hormone Therapy

Hormone therapy blocks certain hormones, mainly estrogen or progesterone, depending on the specific cancer. Much like chemotherapy, this treatment may be used before surgery (to shrink the tumor), during, or after surgery. This treatment have several side effects depending on the type of treatment received. Common side effects are hot flashes, vaginal dryness, or night sweats.

Immunotherapy

Immunotherapy is a type of therapy that utilizes the patient’s own immune system to attack the cancer cells. This therapy impedes the cancer from hijacking the patient’s immune system. Immunotherapy is effective in cases where the patient does not have receptors for estrogen, progesterone, or HER2.

Targeted Medications

This type of treatment strategy uses specific medications to target specific abnormalities in the infected cells. Through research, scientists have found specific abnormalities called the HER2, this is type of protein that assists the cancer cells to grow and survive. By targeting the HER2, it can attack the protein without harming the healthy cells and restricting the growth of cancer cells.

the impact of diagnosis on mental health

Receiving the diagnosis of breast cancer and the subsequent treatments can understandably impact one’s mental health. From experiencing the stages of grief of what was to the treatments’ side effects as well as the impact of the treatment on the patient, there are several areas that can influence the patient’s and their family’s mental health.

Mood changes

One’s mood can be impacted at any stage of breast cancer. In the initial stage of being diagnosed with breast cancer, it can come as a shock if it was a sudden diagnosis. Some patients and their families noted experiencing The Kübler-Ross Five Stages of Grief or anticipatory grief. Certain aforementioned treatments can impact mood by causing hormonal changes, resulting in fluctuations in mood.

Other treatment strategies can also affect mood as a result of the physical side-effects. Increased fatigue and decreased energy can result in depressed mood due the lack of engagement in previously enjoyable activities, energizing movement activities, or general functionality. Surgery can affect how one view’s themselves which impact their self-esteem and mood.

Anxiety

Anxiety is another common mental health condition connected to the diagnosis and treatment of breast cancer. Patients may experience concern and worry about their prognosis and the impact of treatment. Some people who have experienced recurrent breast cancer or other cancers may feel anxious about the effectiveness of treatment this time.

Some individuals who have experienced recurrent breast cancer or other cancers may also experience medical trauma. Medical trauma is an experiential response to pain, serious illness, and medical procedures. Considering that breast cancer can lead to a person feeling a sense of shock, loss of the sense of control, life-altering or even life-threatening treatments/prognoses, and conditions experienced at the hospital and with clinicians, patients develop medical trauma.

Strategies for managing mental health

As important it is to seek medical treatment for breast cancer, it is also important to take care of one’s mental health. As previously mentioned, there are several factors that can impact a patient’s and their family’s mental health. It is important to seek help.

Community support groups are a great resource for patients’ and their families to support each other and to receive support in difficult times. In the Chicagoland area, Lurie Cancer Center lists several local support groups. The National Breast Cancer Foundation also provides some resources on finding support groups nation-wide. American Society of Clinical Oncology also provides some international resources and support in several languages for several different types of cancers.

Individual or family therapy is another strategy that can assist patients and their families cope with the mental health conditions that impact them. In therapy, individuals will have a safe space to process their diagnosis, prognosis, treatment process, and other aspects that may arise during the process. Therapist also assist individuals in the development of coping strategies to manage whatever stressors may arise outside of therapy.

Resources

Breast Cancer

How Breast Cancer can Affect Mental Health

On Death & Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. 50th Anniversary Ed., Dr. Elisabeth Kübler-Ross, Aug 2014.

Elisabeth Kübler-Ross Foundation

Anticipatory Grief: Mourning a Life before it’s Gone, A. Drakulich, 2021.

Public Fact Sheet for Medical Trauma Survivors

Receiving the diagnosis for Breast Cancer can be challenging, however you are not alone. Clinicians at TriWellness are trained in health psychology can provide assistance in this difficult time.

This month’s post was written by our Chronic Illness specialist, Aarti S. Felder, MA, LCPC, BCN.

Schedule an appointment with Aarti S. Felder, MA, LCPC, BCN

mental health and diabetes in asian Americans

Posted on by TriWellness in Uncategorized

types Diabetes

Diabetes or Diabetes Mellitus is a chronic condition that is characterized by one’s body’s inability to convert the glucose (sugar) in food into energy and effects about 537 million adults from the ages of 20-70 around the world, and 1.2 million children ages 0-19 are affected by Diabetes Type I around the world. It is projected to rise to 643 million by 2030 (International Diabetes Federation, 2021). There are four common types of diabetes.

A Snapshot: Diabetes in the United States (Feb 2020, CDC)

Prediabetes

Prediabetes is caused by one’s body not responding to insulin production and resulting in higher levels of blood sugar. A person with prediabetes has an A1C range between 5.7-6.4%, when normally it is less than 5.7%. (A1C is a test that assesses for the percentage of blood that has sugar-coated hemoglobin.) Individuals with Prediabetes commonly exhibit the following risk factors:

  • Overweight
  • +/= 45 years old
  • Immediate familial history of Type II Diabetes (see below)
  • Physical activity less than 3 times per week
  • Polycystic Ovary Syndrome (PCOS)
  • Giving birth to a baby who is more than 9 pounds
  • Gestational Diabetes (see below)

Having Prediabetes can lead to Type II Diabetes (see below) if not managed (CDC).

Prediabetes: Could It Be You? (February 2020, CDC)

Gestational Diabetes

Gestational diabetes is characterized by a pregnant person’s body being affected by insulin production. This can also impact the person’s pregnancy and their baby’s health. Individuals with Gestational Diabetes have a higher risk of developing Type II Diabetes (see below) as well. There aren’t as many symptoms an individual with Gestational Diabetes may experience other than the possibly having increased thirst or more frequent need to urinate. Possible risk factors a pregnant person may be:

  • Overweight or obesity
  • Little to no physical activity
  • Diagnosis of Prediabetes
  • History of gestational diabetes in previous pregnancies
  • PCOS
  • Family history of diabetes
  • History of delivering a baby more than 9 pounds in previous pregnancies

Gestational Diabetes can cause complications in both the pregnant person and the baby. The pregnant person may experience the following complications:

  • High blood pressure
  • Preeclampsia
  • Deliver via C-section
  • Developing Type II Diabetes in the future

The baby of a person with Gestational Diabetes can have the following complications as well:

  • High birth weight leading to complications in delivery
  • Preterm birth
  • Respiratory Distress Syndrome (RDS) which is characterized by experiencing severe breathing difficulties
  • Hypoglycemia (low blood sugar)
  • Developing Type II Diabetes or Obesity in the future
  • Stillbirth

(Mayo Clinic)

Type I DIABETES

Type I Diabetes used to be known as Juvenile Diabetes because it was predominantly diagnosed in children, however it can be diagnosed in adulthood. It is chronic condition that is characterized by a one’s pancreas inability to produce enough insulin. While the causes for Type I Diabetes is still being researched, it is believed that genetics, viral exposure, or environmental factors can cause Type I Diabetes. Treatment is primarily concerned with managing insulin levels, diet, and lifestyle. Common symptoms of Type I Diabetes may be:

  • Increased thirst
  • Frequent urination
  • Unhistorical bed-wetting in children
  • Increase hunger
  • Accidental weight loss
  • Irritability, mood changes
  • Fatigue
  • Feeling physically weak
  • Blurred vision

Individuals with Type I Diabetes can develop further complications throughout their body in the future if blood sugar isn’t managed well:

  • Development of cardiovascular diseases
  • Neuropathy (nerve damage)
  • Nephropathy (kidney damage)
  • Diabetic retinopathy (eye damage)
  • Foot problems
  • Oral complications
  • Dermatological complications
  • Pregnancy complications

(Mayo Clinic)

Type II DIABETES

Diabetes (Type 2) (American College of Cardiology, 2019)

Type II Diabetes is also a chronic condition that is characterized by irregulation of sugar transformation into fuel, resulting in too much sugar in the bloodstream. Type II Diabetes is caused by the pancreas inability to make enough insulin and the body’s cells become resistant to that insulin. While there is no cure for Type II Diabetes, patients can manage the disease with weight loss, proper diet, physical activity, combined with medication. People with Type II Diabetes tend to experience the following symptoms:

  • More thirst
  • Increased urination frequency
  • More hunger
  • Accidental weight loss
  • Fatigue
  • Blurred vision
  • Sores can take awhile to heal
  • Having more infections
  • Numbness or tingling in extremities (hands and feet)
  • Parts of skin are darker than the rest of the skin (often seen on the neck or in the armpits)

Individuals are at higher risk for developing Type II Diabetes if they experience any of these factors:

  • Overweight or obesity
  • Fat distribution is mainly in the abdomen (mens’ waist of 40″+; women’s waist of 35″+)
  • If a person doesn’t use up the sugar through physical activity
  • Other family members have Type II Diabetes
  • High levels of the “bad” cholesterol (triglycerides) and low levels of “good” cholesterol (High-Density Lipoprotein, HDL)
  • The risk of developing Type II Diabetes increases as one ages
  • Prediabetes
  • Gestational Diabetes or giving birth to a baby weighing 9 pounds or more
  • PCOS
Prevent Type 2 Diabetes: Talking to your Patients About Lifestyle Change (February 2020, CDC)

Much like Type I Diabetes, Type II Diabetes can lead to complications throughout the body:

  • Cardiovascular diseases, such as atherosclerosis (high blood pressure and narrow blood vessels)
  • Neuropathy in extremities and other areas of the body
  • Nephropathy
  • Retinopathy
  • Dermatological complications
  • Slow healing; when left untreated, sometimes the cure requires amputation
  • Hearing problems
  • Sleep apnea
  • Dementia

(Mayo Clinic)

Diabetes in the Asian American Community

In the Asian American community, 1 in 3 people are diagnosed with a type of diabetes (CDC, 2022) and is the fifth leading cause of death in AAPI (Joslin Diabetes). At the U.S. Department of Health and Human Services Office of Minority Health published the statistical differences of Asian Americans and their other nationality counterparts. They found that they are 40% more likely to have diabetes than non-Hispanic Whites. From 2017-2018 South-Asian Americans were 70% more likely to develop diabetes in comparison to their non-Hispanic white counterparts (OMH, March 2021). Due to the distribution of fat, primarily the visceral fat (fat distributed around organs), Asians can appear to be at a healthy weight and often under diagnosed with diabetes. As a result, it is recommended than Asian Americans have their A1C checked if their BMI is 23 or greater (CDC, April 2022). As the Asian population is quite diverse, it is difficult to identify the specifics of each subgroup and more research is needed (NIH News Releases, 2015).

Diabetes Impact on Mental Health in Asian Americans

The Mind-Body Connection impacts the individual with diabetes. People with diabetes are two to three times more likely to suffer from depression for various reasons and not many of these individuals are diagnosed and treated. Anxiety and stress can also impact diabetes prognosis (CDC, 2021) due to the manner in which the body burns energy. As diabetes is impacted by diet, individuals can develop Eating Disorders(MHA) and perhaps even Body Dysmorphia due to the weight fluctuations one can endure throughout the disease process. Furthermore the difference in BMI standards to adjust to Asian body types may impact the individual’s view of themselves. Research has noted that the implementation of conjoint intervention of medicine and lifestyle changes (i.e. diet, physical activity, and therapy) can greatly improve the lives of individuals with diabetes.

Resouces

Diabetes Care– ADA’s Standards of Medical Care in Diabetes clinical practice recommendations

Drag ‘n Cook– a resource for Asian food recipes with nutritional information

International Diabetes Federation (IDF)

International Diabetes Federation Diabetes Atlas 10 ed. (2021)

Mayo Clinic The Essential Diabetes Book, 3rd ed., Maria Regina Castro, M.D. (2022)

National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States

Prediabetes– CDC

Prediabetes– Mayo Clinic

Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. doi:10.1001/jama.2015.10029

Type I Diabetes

Type II Diabetes

This month’s article was written by our chronic illness specialist, Aarti S. Felder, MA, LCPC, BCN.

Schedule an appointment with Aarti S. Felder, MA, LCPC, BCN

Neurofeedback and Tinnitus

Posted on by TriWellness in Blog, Uncategorized

What is tinnitus

Tinnitus is a condition characterized by ringing or other noises in one or both ears. Tinnitus can be caused by hearing loss, ear infection, head or neck injuries, certain medications, or symptoms of other health conditions. Tinnitus can also cause other complications from sleep problems, social problems, and other mental health issues.

Tinnitus effects on mental health

anxiety and Stress

Often people pondered the “chicken-or-the-egg” conundrum, does anxiety cause tinnitus or tinnitus cause anxiety? Research continues to try and answer that question. In a longitudinal study examining the correlation between anxiety and tinnitus, the researchers found that those with tinnitus had a high incident rate of anxiety. They further noted that the correlation could be due to anxiety causing tinnitus, tinnitus and anxiety effect each other equally, or that there is another factor affecting both anxiety and tinnitus. Other factors may be genetic or neurological dysfunction (Hou, Yang, Tsai, Shen, Lan, 2020).

There are neurological networks that share commonalities between anxiety and tinnitus. The Limbic System and the Dorsal Cochlear Nucleus (DCN) are thought to be neurological contributors to anxiety and tinnitus. One of the functions of the Limbic System is to manage emotional states. While one of the functions of the DCN converting auditory stimuli in the brain. The proximity of these two neurological networks can possibly affect each other in times of stress.

Regardless of the correlation of anxiety and tinnitus, the end result is still feeling a sense of anxiety and stress. Individuals have noted that they feel more stressed and anxious when they experience increasingly louder ringing in their ears (due to the tinnitus) and in a cyclical fashion they find that the symptoms of tinnitus are further exacerbated, creating significant distress.

Depression

Similarly to anxiety, depression and tinnitus correlation is still being researched. In a scientific review, the researchers arrived to a similar conclusion: depression affects tinnitus, tinnitus causes depression, or depression and tinnitus are symptoms of another condition (Geocze, Mucci, Abranches, de Marco, Penido, 2015). Furthermore, depression and tinnitus can be correlated due to the the neurological proximity and the functionality of the Limbic System and the DCN.

Due to the symptoms of tinnitus being unrelenting, individuals may feel hopeless in achieving relief. These symptoms may also affect sleep, causing fatigue and low energy. Furthermore, it may impact people’s motivation to engage in social activities, resulting in social isolation. All of these secondary symptoms can cause one to become depressed.

Neurofeedback As a treatment for Tinnitus

As previously established, tinnitus has neurological origins. With that understanding, researchers have studied using Neurofeedback as a treatment strategy for tinnitus. In a study, researchers found that Neurofeedback training can assist individuals in controlling their attention to the auditory stimuli, and thusly experienced a reduction in symptoms (Busse, Low, Corona-Strauss, Delb, Strauss, 2008). In another study, researchers found that utilizing Neurofeedback training to modify specific brainwaves, patients with tinnitus has experienced major to complete symptom relief (Dohrmann, Weisz, Schlee, Hartmann, Elbert, 2007).

Neurofeedback is also an affective non-pharmaceutical treatment strategy to treat the aforementioned complications of tinnitus. Studies have shown that Neurofeedback training can reduce anxiety through brainwave regulation. Studies have also shown that Neurofeedback training can assist in establishing normalized neurological activity in individuals experiencing depression.

Resources

Tinnitus

Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study

Systematic Review on the Evidences of an Association between Tinnitus and Depression

Depression in Patients with Tinnitus: A Systematic Review

Tinnitus and Hearing Loss in 15–16-Year-Old Students: Mental Health Symptoms, Substance Use, and Exposure in School

Neurofeedback by Neural Correlates of Auditory Selective Attention as Possible Application for Tinnitus Therapies

Neurofeedback for Treating Tinnitus

Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms

A Review of EEG Biofeedback Treatment of Anxiety Disorders

Clinical Use of an Alpha Asymmetry Neurofeedback Protocol in the Treatment of Mood Disorders: Follow-Up Study One to Five Years Post Therapy

Neurofeedback with anxiety and affective disorders

This month’s post was written by Aarti S. Felder, MA, LCPC, BCN. Aarti is our chronic illness specialist and is a Board Certified Neurofeedback practitioner.

Schedule an appointment with Aarti S. Felder, MA, LCPC, BCn