October 2018 Newsletter: Breastfeeding After Breast Cancer [Special]

By Yu Li P’ing

It is truly terrifying when cancer rears its ugly head – what more when the person affected is in the prime of her life. To commemorate Breast Cancer Awareness Month, here is the story of how one brave mama battled breast cancer and refused to let it stop her from nursing her precious firstborn.

Li Ping survived breast cancer and went on to breastfeed her first child. [Photos courtesy of Yu Li Ping]

MY DIAGNOSIS

I was diagnosed with breast cancer at the age of 33. My husband was the one who first discovered the lump and so we quickly scheduled an ultrasound followed by a biopsy. I still vividly remember the room where the ultrasound was conducted. I immediately knew something was wrong when the technician asked me to wait while she summoned the radiologist, who redid the ultrasound. They were silent while they gazed at the screen, nodding at each other in acknowledgement. I suppose they could not say anything about their diagnosis until it was verified by an oncologist.

That same afternoon, I received the dreaded call from the oncologist. I was asked to go to the hospital immediately. I went with my husband where we were informed of the diagnosis – a Stage 3 ductal carcinoma. In medical terms, the tumour was ER/PR +ve, Her2Neu negative; no lymph nodes were affected and the tumour had not metastasized, so staging was T3N0M0 (see sidebar). Over the course of two hours, we asked loads of questions and were given a detailed treatment plan. I managed to hold it up until the drive home, where I fell apart, devastated. I felt as if I had been completely broken.

Because I was quite young when I was diagnosed (I’d be rich now if I had a dollar for every “oh but you’re so young!” comment), I was hit with every treatment possible – a mastectomy, chemotherapy, radiotherapy and hormonal therapy. I gave myself the superhero persona of ‘Chemo Girl’ to cope with the cocktail of chemicals that the doctors were pouring into me. Thankfully, I responded to treatment very well. After my third chemotherapy session, my tumour had disappeared and a biopsy showed huge, clear margins. Full of relief, I thought I could stop chemotherapy then, but my oncologist said no. I went on to complete all six sessions, followed by the mastectomy and 18 sessions of radiotherapy.

GETTING SUPPORT

Throughout everything, my husband was my solid rock. He was there by my side every step of the way, taking care of everything at home and staying strong for me in the face of so much uncertainty. He supported me completely when I was going through the emotional rollercoaster of accepting and understanding my diagnosis.  My family was another source of strength, encouragement and support throughout the journey. My siblings were my number 1 fans, cheering me on at every milestone I achieved (be it the next round of chemotherapy, radiotherapy or the additional 1km I added to each run I completed). My parents took turns to live with me and care for me round the clock. My father accompanied me throughout my runs on the bicycle and encouraging me to push on. My mother cooked for me tirelessly, making nutritious and delicious food for me. Without their love, prayers and support, I would certainly not be able to have gotten through all that I did. Above all else, my faith in God as well as the prayers of my friends and family lifted me to heights I would’ve never known. My church friends even put a schedule together to bring food for my husband and me. I was surrounded by so much love and blessings!

My oncologist also gave me some great advice. He has the worst bedside manners (bless him!) – he once asked me, “How do you feel?” I replied, “Some days I’m upbeat and other days I just cry non-stop…” He interrupted me uncomfortably and said “No… I meant how do you feel physically? Any pain anywhere?” Being the professorly type, he would willingly debate with me whenever I challenged him on my treatment plan and tried to bargain with him on cutting out treatment that I hoped was unnecessary (of course this was based on my oncology “experience” – namely, Google and heaps of medical research papers). You see, I’m a business developer and I negotiate for a living. I remember printing document after document and highlighting paragraphs to argue my case. But one day very early in the diagnosis, and after he was quite frustrated with my arguments, he told me: “I know you’re battling something that is completely out of your control. You are used to being in control and I’m sorry, but the sooner you realize this is never going to be in your control, the better. Instead, why don’t you spend your energy on what is still in your control – what makes you, you.”

He explained that I need to still keep alive the things that drive me, whether it was my work or my regular exercise. He told me that I needed to protect that and not let the battle with cancer and the treatments take over. So I did just that. I spoke to my manager and made plans to continue working albeit at a much more flexible schedule. I continued running and working out at the gym as much as possible. I would give myself a couple of days rest post-chemo and then got back up running and back to the office. Of course I got weaker due to the cumulative effect of my treatment, and my intermittent breaks got longer before I could get back to work or the gym. A month after my chemotherapy treatment was completed, I joined a 10-km run and never looked back.

Li Ping with her daughter.

MAKING BABY

I took Tamoxifen for three years and due to the good prognosis, my oncologist allowed me to temporarily come off the medication to try for a baby. I would have to complete the remaining two years of my course of Tamoxifen after I weaned. Our conception journey was not easy. We had been informed that with all my treatments, we had less than a 50% chance of conceiving naturally. We tried for 1.5 years, enduring a miscarriage during that time, so when I saw that the pregnancy test was positive again, I remained cautious and could not let myself believe I was truly pregnant until I had completed the first trimester. We were ecstatic about the coming baby! After all that we had been through, the pregnancy was like a ray of light.

I knew I wanted to breastfeed fully and made sure that I read up as much as I could. Ultimately however, I was not prepared for the challenges of breastfeeding. In addition, my gynaecologist and doctors were not too encouraging. They wanted me to get back on Tamoxifen as quickly as possible and I wouldn’t be able to do that if I was breastfeeding. There was unfortunately not much medical support or follow-up provided on breastfeeding after I left the hospital. I depended a lot on breastfeeding forums and websites.

I had to equip myself with information about breastfeeding as a breast cancer survivor but there are very limited resources on this, and no support groups available. I was searching but could not find one. The general breastfeeding support groups were not too helpful for me as the challenges I faced were very different from the average mother.

BREASTFEEDING AS A CANCER SURVIVOR

It was a very difficult time for me after the birth of my child. I was always worried about her wellbeing and if she was thriving on my breast milk. I didn’t want to rely on formula and so I put in the effort to breastfeed and express. At one point I was expressing every two hours, waking through the night in the hope of training my one breast to produce more. I tried every supplement and every galactagogue possible. I had known that I was not likely to be able to fully breastfeed but I still wanted to breastfeed exclusively for as long as I could. On hindsight, I wish I had come to terms earlier about the challenges of only being able to breastfeed with one breast, which had then resulted my baby not getting enough milk from me. I had hoped that my body could compensate and produce enough from just one breast. In the end, I needed to supplement with formula as she was losing too much weight. I developed postnatal anxiety and became completely obsessed with feeding her and making sure my milk supply did not drop. I was not myself and it was one of the hardest times of my life, even worse than when I was battling cancer.

I felt so blessed during this difficult phase because no matter how anxious I was or how down I was feeling, I remember fully enjoying breastfeeding my child and being able to bond with her and comfort her even though my supply was not sufficient. Between the tears of emotional turmoil and physical pain, being able to continue to breastfeed my child and having my husband’s support helped to pull me out of my anxiety. Slowly but surely I recovered and was able to return to work after maternity leave. I decided to seek out donor milk so that I could take my child off formula supplementation. She is now fully breastfed – half from my own supply and half from the kindness of so many amazing mothers on Human Milk for Human Babies. I am so thankful for all of you!

It has been a long and hard journey but I am so proud to have made it through to the other side, with the support and love of my husband, father, mother, sisters and brother.

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ABOUT BREAST CANCER

After someone is diagnosed with breast cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging and describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer’s stage when talking about survival statistics.

The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 7 key pieces of information:

  • The extent (size) of the tumor (T): How large is the cancer?  Has it grown into nearby areas?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs or liver?
  • Estrogen Receptor (ER) status: Does the cancer have the protein called an estrogen receptor?
  • Progesterone Receptor (PR) status: Does the cancer have the protein called a progesterone receptor?
  • Her2/neu (Her2) status: Does the cancer make too much of a protein called Her2?
  • Grade of the cancer (G): How much do the cancer cells look like normal cells?

(taken from cancer.org)

CAN BREAST CANCER SURVIVORS BREASTFEED?

Happily, research indicates that most breast cancer survivors can breastfeed – albeit with a little help. Whether you’ll be able to breastfeed successfully depends on the sort of treatment you have received. Mothers with lumpectomies that have preserved as much ductal tissue as possible may be able to produce some milk from the affected breast. Mothers who have had single mastectomies can most likely produce milk from the remaining breast. By nursing and pumping frequently (things that any mother would have to do to build supply), and with the support of family and a lactation expert, most breast cancer survivors can breastfeed successfully.

Studies show that the highest chance of success is attained when breast cancer survivors receive help from IBCLCs as soon after birth as possible. This ensures that both baby and mother are properly supported through their breastfeeding journey, which may be a little different from most, but achieves the same amazing goals. Don’t be discouraged if your milk supply is not enough for exclusive breastfeeding. You can also consider donor milk, as Li P’ing did, and use a supplemental nursing system (SNS) to feed your child at the breast.