Roxanne Martinez received some of the best news of her life, as well as the worst news, in the same week.
Two years ago, she learned she was expecting her first baby. She also learned that she had breast cancer.
Since then, Martinez, of Fort Worth, has coped with one overwhelming challenge after another: undergoing a mastectomy and chemotherapy while pregnant, raising her daughter, weathering an additional mastectomy and reconstructive surgery, even taking in a relative's baby as a foster child.
Yet Martinez, 32, says her two toddlers keep her too busy to dwell much on the fears that plague many people with cancer.
"Every time I saw the baby's heartbeat and saw her sonogram, it made me happy to know she was healthy and kicking," says Martinez, whose daughter, Serenity, is nearly 1 years old and completely healthy. "But then it would be followed by a chemo appointment."
Martinez and others who have coped with parenting through a cancer diagnosis shared their stories in a recent Twitter chat hosted by USA TODAY.
Though the majority of breast cancers are diagnosed in older women, about 25,000 American women age 45 and under are diagnosed with the disease each year, says Pepper Schedin, a professor at the University of Colorado who researches pregnancy-related and postpartum breast tumors.
More than 18% of all cancer patients have a child under 18 in the home, according to Wonders & Worries, an Austin non-profit that helps children cope with their parents' illnesses.
Parents agree that cancer can cast a dark cloud over what is normally a joyous time. Like Martinez, however, many cancer patients say their children also inspire them to fight.
"I talk about how I raised my daughter. But for me, she raised me up," says breast cancer survivor Teri Fuller of Geneva, Ill. "Especially during chemotherapy, which for me was the hardest part. She was with me throughout. I still remember her rubbing my bald head and laughing."
When Nashville mom Lani Horn was diagnosed with aggressive cancer at age 38, all she could think about, she says, was staying alive for her three young children.
"Every time I thought, 'I can't climb back into that chemo chair,' I thought, 'I have to be able to tell my kids I did everything possible,'" Horn says.
Many parents say they have trouble asking for help. "Some days, I had no idea how I was going to change my daughter's diaper when I didn't even have the energy to walk up the stairs," says Fuller, 36, who found a lump two days after her daughter was born and was diagnosed with breast cancer nine months later.
Christopher Friese, an assistant professor at the University of Michigan School of Nursing, says he urges families to "circle the wagons" and get friends and others to pitch in.
"Be gentle with yourself," says Stephanie Zimmerman, executive director of My Heart, Your Hands, a non-profit serving cancer patients. "Realize that it's OK to accept help, even if it's folding your husband's boxers."
Many hospitals have social workers or cancer navigators who can help patients, as well child-life specialists who can talk to children, says Marisa Minor, who leads MD Anderson Cancer Center's KIWI program, or Kids Inquire, We Inform.
Virginia Borges, an associate professor at the University of Colorado School of Medicine, encourages parents to save some time for themselves, such as by exercising, which can help them keep up their strength and energy.
Patients also need to give themselves time to talk with their partners, Borges says, noting the strain that cancer can put on marriage.
"Kids cope best when the parent is coping," says Meredith Cooper, executive director of Wonders & Worries. "Give yourself permission to care for yourself."
Many women say they struggle with how to talk to their children about their disease. While these conversations will vary depending on a child's age and maturity, experts offer this general advice:
Reassure kids that they won't be abandoned. "Children want to know who will take care of them," Cooper says. Zimmerman, a cancer survivor, says, "I'll never forget the day our son asked, 'Does Daddy know everywhere I need to be and when?'"
But let yourself off the hook. "It's OK to say, 'Sometimes I'm sad, but that's just me. When I take a walk (or nap or whatever), I feel better,'" says Marc Silver, co-author with his daughter Maya of the upcoming book My Parent Has Cancer and It Really Sucks.
"Speak to children early on after diagnosis to make sure they don't hear about it from somebody else," says Minor.
Share the news with your children's teachers and coaches, breast cancer patient Lisa Adams says. "My first call yesterday morning, before I left for surgery, was to reach my daughter's high school psychologist," Adams says.
Keep up rituals and "cancer-free" family time, says Cooper of Wonders & Worries.
Encourage older kids to attend a parent's therapy, Borges says. Children can "see what Mom is going through. They get a chance to ask questions."
Let kids be kids. Tami Boehner, a breast cancer survivor, says, "I don't want my daughter to think she has to take care of me."
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