My Mom's story with anxiety & a surprising diagnosis

Dr. Mia: [00:00:00] Welcome back to ask Dr. Mia podcast conversation on aging. Today's episode is going to be a special episode regarding my mom's story and a surprising diagnosis that we have been dealing with for the past couple weeks.

This is something that. Has been difficult for me to record and I have thought back and forth about whether or not I should record a story about my mom, but I ultimately decided to go ahead and record this because I think. The information and the journey that we've been on so far could potentially be beneficial for other people either in similar situations or even just in completely different situations.

So to begin with, [00:01:00] I wanted to start and tell you all about my mom's background. Her name is Jean. She is 64, although she looks much younger than 64. She's the oldest of three children and she was born and raised in China in the Southern central area in a city called HuaXi. I had mentioned in a previous episode that her mother, my maternal grandmother went to elementary school with my paternal grandfather.

And at an elementary school reunion is how they introduced my parents to each other. When my mom was younger she vividly remembers the cultural revolution that was happening in China. For those of you who don't know the cultural revolution was a time when [00:02:00] China decided to focus in and become A socialist country like Russia.

And during that time, intellectualism, foreigners, any sort of foreign ties were shunned. People were sent to the countryside for manual labor. Both of my parents were teenagers or young adults during that time. My mom was sent to an area where it was very rural and she had to live in a storage facility where basically she was the only person living there quite isolated.

And this was the time before everywhere in China had electricity. after the cultural revolution. She and my father got married. [00:03:00] My dad decided to come to the United States for graduate school. And at that time I was around three or four. My mom was 31 when she decided to immigrate to the United States, she was a meteorologist in China.

and her English was not as good as my father's after they arrived to the United States. My mom worked in a Chinese restaurant to support my father financially while he went to school and she was learning English and her early thirties, although her English is conversational. She has always felt that her English was not as fluent as she wanted it to be.

My mom also has [00:04:00] always been a worrier. She can worry about anything and everything as some people's moms are, it feels like a very productive way to. Think about what could potentially go wrong and potentially prepare for what could go wrong. This could certainly come in handy in her childhood and her early adulthood when there was so much uncertainty and cultural judgment of other people happening in China. Definitely was survival mode for a lot of people. However, her anxiety really got worse after the birth of my brother. She was in the United States with my father [00:05:00] and away from all of her extended family. My brother had a little cold or maybe some trouble breathing shortly after he was born.

And her anxiety became so severe that she really didn't sleep for quite a couple of days, constantly watching him to make sure that he is still breathing when he's asleep. My dad was of course working during that time and really cannot stay home with her. So, they decided to have her stay with one of her extended relatives in New Jersey.

I don't know the full story of how long it took for her to recover from that. But certainly the anxiety has only fluctuated with her life circumstances. I wanted to pause and talk a little bit about anxiety. [00:06:00] I actually looked up a definition of anxiety. It is a feeling of worry nervousness or an ease typically about an imminent event with an uncertain outcome.

I think the uncertainty is what can really drive people's anxiety and this will really come and play again. Later on in this story. I also read somewhere that anxiety could be considered an equation. So anxiety equals the uncertain future or the uncertain outcome, plus the second part is very important an underestimation of our own ability to cope.

My mom has always been a brilliant [00:07:00] woman who learned a whole new field of computer programming and database management. Her job for many years has been solving problems that come up in a large database, working for large companies, in the United States. However, she always felt partly like her job was precarious because her language skills were not as good.

And she felt like she didn't have as many options to switch jobs as perhaps other people. She has never been fired from a job. In fact, she has only been serially promoted to jobs with larger responsibility. However, that underestimation of her own abilities has definitely been part of her typical way of think.[00:08:00] 

Throughout the years, certainly after I started medical school and residency, I became much more aware of her anxiety in the sense that it was generalized. It could really switch from one thing to another. And I really saw how it affected her sleep. She has had trouble going to sleep. and poor sleep hygiene, which is what a lot of people tend to do, where they fall asleep on the couch in front of the TV, and they may snooze for a couple hours.

And then when they wake up, they trans transition to their bedroom, but have a hard time falling asleep and may toss and turn for hours at night, I tried to talk to her. About the connection between her mind, her [00:09:00] anxiety and the never ending thoughts that seemed to be running through her brain and its connection within insomnia.

But she really felt like she was very hesitant to take any sort of medications. She always felt that her anxiety was situational. Even though situations may change and come and go. But her anxiety only fluctuates in terms of intensity. I didn't find out until later in life that she has periodically talk with a therapist.

But never for any sustained periods of time. Culturally it's very much not the norm to speak about one's quote, unquote, weaknesses [00:10:00] or family, dirty laundry to outsiders. There's very much a term called saving face in Chinese culture, where you have to put up a good front towards the public towards the outside and only confidential items can be discussed among family members.

This was certainly a barrier in talking with therapists about anything that's going on in her life that may be difficult to discuss.

A couple years ago, my mom unfortunately, was diagnosed with Parkinson's disease, but the diagnosis took quite a long time. Initially she noticed that her walking was a little bit off where she seemed to be stepping with one side of her body [00:11:00] and it would come and go. Whenever she walked for an extended amount of time, particularly in China when she was visiting friends or family, they would comment on that her gait was not the same as before. She has seen different neurologists in China. And some of them said that she did have Parkinson's disease while others said that she definitely did not have Parkinson's disease. It wasn't until I connected her with a movement disorder neurologist that the diagnosis really became clear.

My mom has always been extremely healthy and very, very much up to date on medical news. In fact, she [00:12:00] listened for years to an NPR national public radio program called people's pharmacy and heard all kinds of information that she still remembers today. Initially, she was hesitant to take medication for Parkinson's because she did not notice that it helped very much with her motor symptoms, but eventually we did convince her to take it.

But what really made an impact for her Parkinson's is really a very specific, gym that helps people with all different levels of Parkinson's disease get better in terms of Parkinson's specific exercises. As of [00:13:00] July of this year, she was able to walk a lot smoother. She took multiple laps around her neighborhood.

And friends and neighbors would stop by and comment on how well she seems to be doing things seemed to be going quite well. At the end of August, she started complaining of some abdominal discomfort that would wake her up in the middle of the night. And it would, it was interfering with her sleep.

Though her sleep was never very good. We talked about it possibly being acid reflux. She tried over the counter acid reflux medicines, but it didn't seem to get any better. And one day we were FaceTiming each other and she showed me that her belly has [00:14:00] gotten bigger. She's always been a very thin woman and it was unusual to see that her belly was a lot more full.

I thought, again, that maybe this is acid reflex and maybe she has gas suggested that she takes some gas medications over the counter and. Still didn't really seem to make a difference, but I definitely encouraged her to talk more specifically with her primary care doctor. Her primary care doctor saw her and initially ordered an outpatient ultrasound, but before she was able to get to that outpatient ultrasound, she started having.

Problems with shortness of breath. And, she and my father went to the emergency room [00:15:00] and they called me talking about the fact that they were in an emergency room about an hour and a half away from where I currently live. 

After an initial CT scan of her abdomen, that was without IV contrast, the doctors initially thought that her liver was abnormal. They drained the fluid in her belly and send it to the lab to look under the microscope.

After draining about three liters of fluid from her belly, they scan her again this time with contrast. And unfortunately it showed a very large ovarian mass that is most likely to be ovarian cancer. Interestingly, this was one of the diagnoses that she [00:16:00] worried about for a long time. She had heard of other people in the Chinese American community getting diagnosed with cancer, although she has never had any family history of cancer in either one of her parents' side, she had heard a long time ago on, people's pharmacy, that belly distinction could be a sign of ovarian cancer.

I was sort of joking with the emergency room doctors when we were discussing the potential diagnoses. And I said that my mom might be actually right in terms of worrying about the worst diagnosis that could potentially happen. For those of you who have [00:17:00] access to a patient portal, sometimes it is both a blessing and a curse, a blessing in a sense for a family members or other caregivers who could review medical records on online, as well as communicating directly with your loved ones, doctors, advanced practice practitioners, look over their lab and other imaging findings. For my mom in particular, she not only is not confident in her English abilities. She also felt like she would be a bother to the doctors if she asked too many questions. but then she would turn around and immediately ask me all the questions that she didn't feel comfortable asking the doctor. So it was very helpful for me to be able to [00:18:00] access her my my chart portal or patient portal, the curse. However, is that her imaging finding the second CT scan of her belly was immediately released to the portal overnight. And during the night, when she could sleep in the hospital, she looked at the report and saw that it was concerning for ovarian neoplasm. She called me a couple hours later and sent me a screenshot of what the report said. Obviously had a lot of medical terminology because the radiologists were reporting it really to the physician who ordered the test.

But unfortunately I had to confirm to my mom that she in fact did look like she [00:19:00] had ovarian cancer.

 I know as a physician, that there are ways of delaying release of information in the process of ordering things on the computer. Oftentimes those little clicks and check boxes could be easily missed. And especially when scans are done without any prior thought of cancer, it can be difficult to determine ahead of time, whether scan could be potentially harmful for the patient to see. I say all this, not to necessarily blame the physician who took care of her in the hospital and the order entry system, but [00:20:00] merely to say that there are so many unpredictable things happening when people are hospitalized or when they're in our healthcare system, that even a physician daughter like me have limited control.

Obviously the diagnosis of ovarian cancer was quite shocking and it took another week or so to wait for the lab to confirm from the fluid that was taken off of her belly, the, during the first hospitalization that they were indeed signs of ovarian cancer cells,

The initial parts of a new, severe illness like cancer is a lot of [00:21:00] shock and grief. I can't speak on the experience for my mom because I'm not her, but speaking for my own self, hearing the news as a family member it was difficult. Um, It was difficult to grieve, not only for her, but for the future of what I imagined, our relationship and her relationship with her grandchildren, my children to be, and grief is a feeling that thankfully, or unfortunately, I've had some experiences [00:22:00] with. And one thing that I always try to remind folks is that grief is really like waves in an ocean. It's a continual cycle of acceptance grief, acceptance, grief. Until one day, the waves are just not as big as they initially were, but anniversaries or certain things or smells could really remind you of the person you lost or the future that you envision yourself having.

And during this process, I really try to process my emotions as they came. And when I say the words processing emotions, [00:23:00] I want to clarify what that means, because this is a relatively recent skill set that I learned for myself as well. Processing emotions means we are aware of how it feels in our body.

In addition to naming the emotion, we're not trying to push away this uncomfortable emotion into what I call a buffer, where this could be anything that's temporarily enjoyable, like alcohol, food, social media, our phone, or maybe even working something that, that temporarily gives us a sense of control or enjoyment. But really after that temporary feeling is gone, you end up feeling [00:24:00] worse than in the beginning. That's really avoiding emotion and trying to distract ourselves,

Reacting to emotion means that we are lashing out our internal discomfort unto other people. This could be perhaps having a bad day at work, but not being able to release that emotion. At work and coming home and releasing those negative emotions onto the people we love the most, our family. I definitely fall into that as well. And thankfully my husband calls me out on it when he notices that I am [00:25:00] releasing or projecting my uncomfortable emotions on him. So processing emotion means that we're not trying to resist emotion. We're not trying to push it away or give it to other people. We're just staying in that space of discomfort.

but naming what it is that we're feeling. I imagine it as explaining how we feel to an alien, what is the vibration going on in my body that feels like grief, or anger or sadness or frustration. And each one of those emotions have a different vibration in my body. And at different times [00:26:00] or different waves or grief, I've also noticed that they feel differently in different parts of my body.

For example, when the first wave of grief came. I felt it a lot more acutely in my chest and in my throat, I felt short of breath and that my chest was tightening while it is very uncomfortable to focus on the feeling. And it seems counterintuitive, but actually processing our emotion and identifying what it is that we're feeling.

Actually helps us move past or accept that emotion much more quickly than if we push it away or try to distract ourselves from it. Ultimately in my mind, there are [00:27:00] no quote unquote negative emotions because every emotion is really a reaction to a thought that we're having.

Processing emotions have certainly helped me accept and continually accept her diagnosis and the complications that she has experienced since that initial diagnosis. I was noticing the other day that when there were additional updates, To her health, even though I have accepted it, there came another wave of sadness.

But this time I felt a lower in my stomach and the tightness of my chest didn't seem as tight. [00:28:00] So I took some deep breath and reminded myself again, this is grief. This is sadness. There's nothing wrong with having these emotions, but that I am human and reacting as humanly as one could expect in this particular scenario.

I wanted to say all of this to really try to encourage listeners like you, in terms of naming your emotions, whether they're happy, ones like joy or gratitude or content or less comfortable ones like anger, guilt, shame, sadness. There are no [00:29:00] emotions that could really kill us, thankfully, even though they feel terrible, but counter to our intuition, trying to avoid the uncomfortable emotions really prolong how long they stay.

So obviously my mom's journey my journey as her medical advocate or physician daughter is just in the beginning. I may come back to her story later on in future episodes. If I think what I am going through could potentially be helpful for other people.

I hope you can share this episode with other [00:30:00] people. I also wanna encourage those of you, whether you have lifelong anxiety or temporary anxiety to talk to people you trust about how you're feeling. I wanna say that mental health is not just a biological change in our minds or in our brains, but it's multiple facets from our past, from our prior experiences, from our current level of support or lack thereof, from the thoughts that we have in our brain, especially the ones that we say to ourselves over and over. We may not even notice that we're saying very negative things to ourselves that we would never say to [00:31:00] another person, much less someone we love, but we say those things to ourselves, just being aware of those thoughts could really be helpful in addition to considering taking medications for your mood.

I think it's incredibly common to have depression and anxiety, and there is still a stigma. Unfortunately, especially around healthcare professionals to admit that their emotional health is not as good as they want it to be.

But with all that said, if you are feeling sad or down or hopeless, please talk to your doctors. Or check out some of the online resources that I will put in the show notes. The suicide prevention [00:32:00] hotline has recently changed to 9 88 for those of you who don't know. And that could be something that you let other folks know as well, because unfortunately suicide is also incredibly common, not only in the general pub public, but also in people in helping professions. So with all that said, thank you for joining me and talking about my mom's story. See you next time.