The terrifying discovery of the lump in their breasts. The surgery, the chemo, the radiation. All of that was behind them, maybe six months behind them, maybe five years behind them. But behind them.
The women had taken up life where it had stopped, suddenly, with the devastating diagnosis of breast cancer. Taking care of husbands, kids, aging parents. Working, cooking, cleaning, volunteering. And everyone around them was so happy to see them back.
But these women weren't back.
Dr. Kathy J. Helzlsouer, breast cancer specialist at Mercy Medical Center, was hearing whispered complaints of fatigue. After all these women had survived -- it seemed silly, even ungrateful, to complain. But they were exhausted. Bone tired, dead tired. And sleep did nothing to restore them.
"They kept telling us, 'I'm not where I was before,'" said Helzlsouer, head of Mercy's Prevention and Research Center. "They are balancing family and work, but they are dragging themselves through their days. And this might be five years after their treatment."
So three years ago, with Mercy's support and some grant money from the Maryland affiliate of the Susan G. Komen for the Cure Foundation, Helzlsouer put together a team and a program and asked some 60 women cancer survivors to commit to just one more thing -- a 10-week program that might help them get all the way back.
"They were so tired, it was hard for them to do this," she said. "But once the program got started, they were hooked."
Helzlsouer's team includes Susan Appling and Susan Scarvalone, who focus on quality of life issues with breast cancer survivors, physical therapist Maureen McBeth and yoga teacher Stephannie Weikert.
They worked to help the women understand that the fatigue was the result of the lingering stresses of a major illness -- waiting for the illness to return, chief among them -- and that it was their busy, unhappy minds that would not allow them to truly rest.
They taught the women meditation techniques, guided imagery and ways to battle back distorted thinking.
They taught the women about the parts of the sleep cycle, the causes of sleep disorders and small housekeeping steps they could take to improve their sleep.
They taught them about nutrition and portion control and enough food science to help them improve their diets and lose the weight that can be a dismaying result of the medications for breast cancer.
And they taught the women yoga, explaining how this meditative exercise can reduce stress and override the damage stress can do to the body, while restoring strength, muscle tone and flexibility.
This was the toughest part -- overcoming the powerful aversion these exhausted women had to even the idea of exercise.
Meditation? Yoga? The impact of fans and white noise on sleep? Good nutrition? These might sound like the elements of fuzzy science, but Helzlsouer and her team found profound and long-term improvements in the lives of these women.
Tracking symptoms concretely, with blood work and other measures, the Mercy group found improvements in the fatigue scores as well as vitality scores. In other words, the energy and mood of the women improved -- and it stayed that way for six more months, after the 10-week program ended.
"That really surprised us," said Helzlsouer. "That it persisted."
Mercy now offers the 10-week program that resulted from this study to breast cancer survivors, and hopes to expand it to the treatment of fatigue in other patients with chronic illnesses. With the support of Komen, there is no charge, but the hospital is grateful for donations.
"Forty percent of women breast cancer survivors will have this pervasive and devastating fatigue," said Helzlsouer. The Mercy study has legitimized a symptom that many of these women found no help for in the offices of their surgeons or oncologists.
"After something like breast cancer, women have to find a new self," she said. "This can help."