Managing Difficult Anxiety: Liz Marshall Metcalfe

Written by Robin Warshaw, Contributing Writer On and off since high school, Liz Marshall Metcalfe has experienced fearful, worried thoughts and feelings. She had anxiety that often focused on health and physical symptoms. “I’d get a twinge or tightness in my chest and would think I had a heart attack,” says Liz, who lives in Kenmore, New York. “It was very irrational.” Shortly after the anxiety began, Liz’s mother developed pain, dizziness and weight loss that doctors could not link to a cause. She was later diagnosed with primary amyloidosis, a rare disease in which protein deposits form that the body can’t break down. She died when Liz was 18. The following year, Liz’s father was treated for laryngeal cancer. In college, Liz sometimes took prescription medicines for the anxiety but she didn’t like using them. “Taking medication for anxiety felt sort of like I was failing,” she says. “I did my best to avoid it, to varying degrees of success.” Over the years, she tried cognitive behavioral therapy – a type of talk therapy that focuses on specific problems and finding ways to solve them– and tried other complementary therapies.  Those approaches helped for a while, but she still had cycles of anxiety. When she was 36, Liz received a breast cancer diagnosis. She had stage II, hormone receptor-positive, HER2-negative, node-positive disease, with DCIS in the same breast. That diagnosis “was all my worst fears coming true,” Liz says. It “just threw my anxiety into complete overdrive.” When Worry Takes Over Feeling anxious after a breast cancer diagnosis is understandable. Young women may worry about test results, treatment choices, body and fertility changes, or how a diagnosis might affect work, relationships and children. They also may feel tension or dread without a specific reason. This distress can be temporary but sometimes becomes intense and doesn’t go away. For Liz, anxiety about side effects took the greatest emotional toll. “With chemo, you’re feeling things that you’ve never felt before,” she says, “and you don’t know what’s happening next.” She was exhausted, nauseated and her knuckles and fingernails changed color. A herpes infection in her esophagus, caused by chemotherapy, created a burning feeling in her chest and back. She needed to have an endoscopy, in which doctors inserted a scope into her throat. This added to her feeling overwhelmed by treatment and its effects. During chemotherapy Liz became anxious about leaving home. Sitting alone when her husband wasn’t there would cause her to have upsetting thoughts. “It was a fear of the unknown or a random occurrence,” she says. “My brain can be my worst enemy.” She worried about going to her university job and having fearful feelings there. One day, while shopping in a store, Liz felt panicked and that she had to leave as soon as she could. At the start of chemotherapy, her oncologist gave her an anti-anxiety medicine for nausea and sleeping problems. The doctor said she should also use it for anxiety as needed. She went for walks, did yoga and meditation, and used deep breathing techniques to calm herself. She even tried adult coloring books. “People have been throwing them at me,” she says, with a laugh. She talked with a psychotherapist at her cancer center who said Liz was doing everything the therapist would advise. She also was in a clinical trial studying the use of a guided imagery relaxation recording, a technique in which a person is guided to imagine a positive scene, when she felt anxious. “I think it helped to a point,” says Liz, “but I needed more than that to deal with what I was dealing with.”Finding Help Finally, she talked with her doctor about her intense feelings. On her next-to-last chemotherapy round, she was prescribed a light dose of an antidepressant that also treats anxiety. She started feeling better soon after and is still taking it several months later. “My mind has felt so much more at ease…and I’ve made peace with needing some extra help with my anxiety as I navigate Cancerland,” Liz says. Talking with friends and people in online breast cancer groups has helped, too. She no longer thinks taking medicine is a sign of defeat. “As my doctors have told me, there’s no reason why I shouldn’t use any tool at my disposal to help me through.” Liz describes herself as having been “pretty calm” when dealing with surgery she had to get after chemotherapy. She heard her pathology results without having an anxiety surge. And after finishing radiation therapy, she plans to get back to yoga too. Next up for Liz: hormonal therapy. “I’m focused more on looking ahead now,” she says. ### Visit LBBC.ORG to learn more about anxiety and depression in young women.

This article was supported by the Grant or Cooperative Agreement Number 1 U58 DP005403, funded by the Centers for Disease Control and Prevention. Its contents are