“If you want a happy ending, that depends, of course, on where you stop your story.”
Orson Welles director, actor and producer
Honestly, this blog is supposed to be funny, but sometimes it’s hard to get there.
I am a cancer survivor. You cannot imagine how good it feels to write that. This blog was established to help me document my journey, process my experiences and, ultimately, inch away from thinking of myself as a cancer patient and towards being a mindful, peaceful and accepting (that’s a tough one!) creature on this Earth. Be warned, some of my posts are self-indulgent and unnecessarily wordy; I have much respect for anyone willing to slog through them.
Right now, this blog is anonymous: I need to stumble through my feelings, complain when I feel like it and be blunt when necessary — and I need a safe space to do it without fear of judgmental glances. While my goal is to keep this light-hearted, I realize that I have the pleasure of being a survivor and chuckling about my cancer experience; there are many who are not granted that opportunity. Writing this blog is a privilege.
Cancer sucks. It’s an indiscriminate spectre that has haunted the lives of practically everyone at some point, whether relatives, friends or ourselves. For me, cancer cannot pass into faded memory quickly enough, but at the same time, I am infernally curious about the disease and how it has changed me.
So here are my facts:
In early 2017, I was diagnosed with triple-positive (estrogen+, progesterone+ and HER2+) breast cancer. The lump was 1.6cm in diameter, removed at the end of March, along with three sentinel lymph nodes that were revealed to be unaffected. Chemotherapy (Taxotere & carboplatin) started a month later and lasted the entire summer, 6 hefty courses, one every three weeks; adjuvant therapy (Herceptin, a monoclonal antibody) also started at this time, but went for 17 courses, ending in April 2018. Daily radiation treatment lasted six weeks through autumn of 2017. A 3-D mammogram in February 2018 showed nothing, in a good way. That marked my first year without the tumor.
I wish I’d been able to write in 2017, but my head wasn’t there. I was not processing, I was existing and enduring. After my final Herceptin infusion, my port was removed and I turned around to see what had happened. It took several months of writing before I tossed out my first post in September 2018, privately at first, and then, “Hello, world!”
It’s going to be a bumpy, unpolished ride. Bear with me.
The thing about cancer is that the news hits you hard at once.
And it’s not like you get time to get used to it, because the diagnosis is LOADED. All those scary things that you’ve ever associated with the “big C” rush at you and there’s no real way to protect yourself.
It would be terrifying for anyone, but those of us currently in mid-life grew up at a time when cancer treatment was not as refined or targeted as it is now: visions abound of hospital beds, bald heads, bodies wasting away, vomiting, hopelessness. Most cancers were frequently fatal and diagnosis was the beginning of the end.
As we’re trying to process what this all means for us, for our future and for our families, others try to prop us up with cheers of, “Be a badass!” “Stay strong!” “You’ll beat this!” “You’re a fighter!”
So between juggling the cancer news and the “hang tough” messages from those around us, everything gets overwhelming. Our oncologist lays out a treatment plan and suddenly we need to learn a different language. Tumor types, chemo drugs, clinical terms, side effects.
I distinctly remember wanting to hide under my bed and wait for it to go away. There was so much I needed to do and I didn’t know how to get through it all. It seemed like an immense amount of work for one person.
And then it hit me. All I needed to do was show up.
I didn’t need to be the warrior that everyone was pushing me to be. The mere fact that I was going to my appointments on my scheduled day was enough. I wasn’t going to win a prize for being the best “infusee” or for absorbing the most radiation the fastest.
I didn’t have to fight. All I needed to do was endure and allow. To accept what was going on and move through it. And to breathe.
I brought my office work with me to my first infusion. I was going to be there for at least 5 hours so I figured I should use the time “wisely”. I fired up my laptop but soon the Benadryl that I was given to prevent adverse reactions kicked in and brought on drowsiness.
Suffice it to say I might have answered an email here or there, but did little else. The same thing happened during the next infusion, and the one after that. Eventually I realized that the wisest way I could spend my time was by giving myself permission to rest and ride out the treatments.
When infusion day rolled around, I learned to put aside my work duties and family responsibilities, and simply be. It was such an uncomplicated concept, the benefits of which rippled out beyond my treatment. Why did it take cancer to teach me that?
I’m still experiencing weird sleep disruptions. Many nights I’ll be up for an extended time during the wee hours of the morning.
This isn’t conducive to being bright and alert during the day, so I’m devising a game plan for limiting the length of these nighttime interruptions.
My newest strategy is a variant of a counting practice that I heard over the radio years ago, and it goes like this:
Imagine a clean whiteboard. In one hand you’re holding a dry-erase marker in your favorite color, in the other a cloth or eraser.
Write “100” in large numbers, but do it backwards so it looks like a mirror image. Channel your inner da Vinci. 🙂
Then erase the number and write “99”, again reversed. Erase it again.
Keep counting down. Don’t rush. Think about how your hand should move to scribe the backwards numbers. Breathe deeply. When you erase, erase carefully and completely.
You probably won’t get to zero. The first two nights I did this, I didn’t make it past 80. It doesn’t always work so well, but when it does, it’s soothing and sleep-inducing.
Why does it put you to sleep? First, you’re not doing anything very complex and therefore this shouldn’t be putting you into a greater state of wakefulness; in fact, counting down is kind of boring. You’re giving your full focus to this task so there are fewer opportunities for intrusive thoughts to interrupt. If they do, return your focus to the numbers. Do this each time your mind wanders. And while the task is easy enough, it does require you to pause and consider how to move your hand, since you’re doing the opposite of what you usually do to write a number.
The counting task requires enough attention that you shift your focus away from thoughts that may be keeping you up, but is gentle enough to lull you into a calmer state that helps bring on sleep.
If imagining a whiteboard doesn’t work for you in the middle of the night, there are other counting variations that would work as well:
Starting from 100, simply count backwards by threes (no imaginary writing required). If 100 seems too optimistically small a number from which to start, use 300 or even 1000. If counting down by threes seems too complex, try twos. Go slow.
Really good at addition? Try calculating the Fibonacci Sequence, a series of numbers where the next number is the sum of the two preceeding it. Start from zero, add one and then keep going: 0, 1, 1, 2, 3, 5, 8, 13, 21, 34… unfortunately, this can get out of control quickly (I usually lose track somewhere in the three-digit numbers). But intrepid math fans might be able to get far enough to refocus themselves to the present and enter a calmer state.
Does the idea of math cause you stress? Then just count your breaths, start from 100 and going backwards, slowing down the breathing as you go, imagining the numbers count down with each inhale. This works particularly well if you focus on releasing all your muscles with each exhale.
A specific strategy may not work every time, but the overall idea is the same: something that requires a little brain focus with minimal excitation or strain (so that you can lazily shift your focus and keep your mind gently occupied). Do not rush through these; the magic lies in the process. There is nothing to achieve here. You’re simply boring yourself to sleep.
Try any of these the next time you find yourself awake with a racing mind and let me know how it goes.
When is a “chemo port” not a chemo port? When it’s a heart rate monitor. Except that my emotional brain can’t tell the difference.
For anyone unfamiliar with cancer chemotherapy, a chemo port, or subcutaneous implantable catheter, is a device implanted under the skin (usually on the chest) that is accessed during an infusion to enable easy mixing of the chemo drugs with blood within a major blood vessel. This avoids a good deal of injury to any smaller blood vessels, were you to get chemo drugs via an IV to your arm. (For more info, see this post.)
As much of a blessing as the chemo port is, having a foreign object pushing up from the chest wall under your skin can give “Alien” (as in the movie) vibes. For me personally, the implanted chemo port was more psychologically taxing than I anticipated, and as soon as all my infusions were done, which took a year, I had it taken out ASAP.
So almost three years after its removal, the chemo port is spooking me again, this time in the form of an extended Holter monitor for continuous heart rate recording, which I’ll have on for almost two weeks. It’s taped to the skin in a fancy patch that you can exercise and shower in, and supposedly you forget that you’re wearing it and go on your daily routine as normal.
But for me, it’s bringing up the spectre of chemo port, and memories of discomfort and pain I felt having that bulge stretching my skin of my chest. I chant my mantra of “it’s ON, not IN” in an effort to distinguish between the port and monitor, but the longer than it stays on, the more anxiety I feel about it.
All those emotions about the lack of control over my own body, feeling so abnormal and outwardly looking “sick” (not to mention fear of death) are rushing back. The Holter monitor peeks up from the neckline of my shirt, hooks my car’s seatbelt and often seems to be in the way. I find myself moving away from other people in fear of having them knock it or hug me too tightly and cause pain, even though the monitor doesn’t deserve the same apprehension that the port did.
I’m removing the Holter patch today and sending it back for analysis, so that’ll be a big relief. But the power of this reaction is another reminder of the depth of fear that the cancer experience placed within me.
So why am I wearing the heart rate monitor anyway? I was having little cardiac “episodes”, particularly over the last year, and this was one of the (many) reasons for discontinuing aromatase inhibitors. Mainly these were sensations of skipped or extra beats or an odd “fluttering”. I’ve already had an EKG and echocardiogram, neither of which apparently showed anything abnormal (I haven’t received a final report of my echocardiogram but had been told that the cardiologist would contact me if he found anything problematic, and it’s been a week and a half, so I’m guessing everything’s okay?).
The Holter monitor was the last step in looking for arrhythmias or similar issues. And wouldn’t you know it? The further I’ve gotten from stopping aromatase inhibitors, the fewer episodes I’ve experienced and haven’t felt anything distinct since I got the monitor. What I’m feeling is very occasional, subtle “sensations”…but these may turn out to be nothing. I’m okay with that. As a matter of fact, I’m not even worried about what the data might show.
IMPORTANT: Please discuss the information below with your oncological and nutritional team prior to making changes to your diet!They will be able to provide you with the proper guidelines for your situation.
One common area of contention within the context of hormone-positive breast cancer is the effect of soy consumption on cancer risk. There has been some back-and-forth on this topic, and “to soy or not to soy?” is a frequently-heard question coming from newly-diagnosed cancer patients.
It was a concern for me. I became vegetarian at age 18 and consumed a soy-heavy diet until my mid-40s, at which point, partly spooked by warnings about soy, I backed off. As recent research shows, I needn’t have.
For a little background, the main concern for breast cancer patients is the presence of phytoestrogens in soy, known as isoflavones, and how they function in the human body. They have a mild estrogenic effect, which is why many women use them in supplement form to ameliorate the uncomfortable effects of menopause. In that sense, they are acting like estrogen, although it’s important to stress that they are not estrogen.
But given this similarity to estrogen, does soy increase the risk of breast cancer and breast cancer recurrence? In short, studies show that if you grew up eating soy and eat it daily, as is the case in many Asian countries where soy products are dietary staples, soy has a significant protective effective against breast cancer. Results of these studies have been inconclusive in Western populations, however this seems to be due to differences in diet: not only do Westerners eat considerably less soy compared to Asians, they also don’t eat it throughout all stages of their lives.
Is there a difference in how these diverse cultures handle isoflavones? It appears that a major isoflavone-derived metabolite, equol, has well-documented antioxidant and estrogen-like actions and seems to be associated with numerous positive outcomes, but only about 30-50% of the human population has the gut microbiota to derive it from the diet. There is a need for more research on how this conversion takes place and under what conditions.
But most importantly, as stated by the American Institute for Cancer Research, “Population studies don’t link soy consumption with an increased risk of any cancer.” While the childhood and adolescent consumption of soy is what seems to offer the most long-term benefits, for those who increased their intake at a later age or don’t eat it regularly, the current view is that even if eating soy doesn’t significantly reduce your risk of cancer, there is no definitive evidence that it will make your risk worse.
For me, that means that I will continue using soy as an important protein source in my diet.
Overdoing anything is not good, so don’t overload on overly processed soy supplements in the hopes of preventing cancer development and/or recurrence — particularly if you’re postmenopausal and not a life-long soy eater. Having said that, there is ample room for minimally-processed soy foods (tofu, edamame, tempeh, miso) in a healthy plant-based diet, and that will definitely benefit you.
No single thing will prevent cancer 100%, so you’d be well-served to consider your lifestyle as a whole. As a matter of fact, Zhang et al. (2017, Cancer) noted that “[w]omen who consumed high levels of dietary isoflavone were more likely to be Asian Americans, young, premenopausal, physically active, more educated, not overweight or obese, never smokers, and drank either no alcohol or <7 drinks per week.” [Emphasis mine.] That means protection came not only from soy; the women were also engaging in other behaviors associated with a lower risk of breast cancer. Bottom line, lifestyle matters!
Finally, this is only a brief summary of what I found. Soy is a topic that I’ll be keeping my eye on and will report back as newer studies are published.
In the meantime, here are three excellent reader-friendly websites for more information:
References for this post (all articles are available online free of charge):
Baglia ML, Zheng W, Li H, Yang G, Gao J, Gao Y-T, Shu X-O (2016) The association of soy food consumption with the risk of subtype of breast cancers defined by hormone receptor and HER2 status. Int J Cancer. 139: 742–748. https://doi.org/10.1002/ijc.30117
Lee SA, Shu XO, Li H, Yang G, Cai H, Wen W, Ji BT, Gao J, Gao YT, Zheng W (2009) Adolescent and adult soy food intake and breast cancer risk: results from the Shanghai Women’s Health Study. Am J Clin Nutr. 89: 1920-1926. https://doi.org/10.3945/ajcn.2008.27361
Mayo B, Vázquez L, Flórez AB (2019) Equol: A bacterial metabolite from the daidzein isoflavone and its presumed beneficial health effects. Nutrients. 11: 2231. https://doi.org/10.3390/nu11092231
Zhang FF, Haslam DE, Terry MB, Knight JA, Andrulis IL, Daly MB, Buys SS, John EM (2017) Dietary isoflavone intake and all‐cause mortality in breast cancer survivors: The Breast Cancer Family Registry. Cancer. 123: 2070-2079. https://doi.org/10.1002/cncr.30615
When I asked my oncologist about soy, he shrugged and said, “Yes, it’s true that soy foods contain plant estrogens…but you’re not a plant.”
If there is a time that I’m going to feel anxiety, there’s a good chance it’ll be during my yearly mammogram. This year it came around the same time that my oncologist gave me permission to stop letrozole (and there was stress preceeding that appointment), but also great fear associated with my perceived cardiac arrhythmias, for which I have several visits with a cardiologist lined up.
To top that off, a family stressor followed on its heels, which I won’t go into but one that portends difficulties in the future. This last anxiety-provoking event used the previous stressors as a springboard and exploded into something even bigger. I was primed for anxiety and it took me for a ride until I found the traction to dig my heels in and slow down.
The worst part is, none of this stuff will simply go away.
Often, when people speak of anxiety-provoking events, they’re described as stressful things like a tense meeting with the boss or college finals or tight work deadlines. Admittedly these are all nerve-wracking, but they are also time-limited.
Then we have something like cancer.
I remember listening to a talk about anxiety where the lecturer tried to give the audience perspective about what was really going on, and he asked: what’s the worst thing that could happen? “You’re not going to die,” he assured us. And it’s true: let’s say that you fail all your final exams, but you’ll survive, even if you have to retake the classes.
Cancer survivors can attest to the fact that we suffer a different flavor of anxiety. There is no deadline on our stresses. They are thick and cling to us, like caramel sauce on the inside of a coffee cup, thinned by the passage of time, but leaving a film on our lives. Our hope is to get past the two-year mark, then five. Ten, if we’re so lucky.
Often, we hear about the success of treatments only to realize that the success is based on the majority of patients lasting until the end of the study, which might have been only five years.
Having someone tell you that you have a 95% chance of surviving five years is, well, underwhelming, especially for those of us who had premenopausal breast cancer. I mean, yeah, I HOPE I can last five years.
So, what to do? If there were ever a time to practice non-attachment, this is it. For some of us (present company included), it is excruciatingly difficulty to release expectations–I want, even NEED, to be assured that everything will be okay and then rest easy with that.
But I promise you, clinging to the desire for things to be different only causes suffering. It also robs you of the joy of what you are experiencing right NOW–a beautiful sunrise, the softness of a pet’s fur, the richness of a cup of coffee, the coziness of a warm blanket. We are so wrapped up in fears of what the future holds that we miss the magic of what is before us.
Now is the only moment that exists, so truly, it’s the only moment that is real and certain.
Everything else is either history or what we concoct in our minds.
So this time of the year, I have to sit back and sense the Earth under my feet, feeling into how it supports me. This is what it feels like to be here now. No matter how many times I remind myself of this, I know I’ll have to do it again when the next stressor hits. That’s okay.
This isn’t the first time I’ve written about anxiety and it certainly won’t be the last. But practicing mindfulness, every time I go through this experience, I reign in my emotions a little earlier and start feeling better a little faster. When I look back at what happened I realize I’m making progress, and that’s what really matters.
That shouldn’t be surprising, given that it was my “scan-week” of the year, but even I was taken aback by how I’d felt.
For at least two weeks prior, I’d had that low grade, persistent anxiety simmering, the kind that you can *mostly* ignore during the day, but wow, does it rear its ugly head at night. I’d fall asleep, only to wake several hours later and then the mental battle of focusing on my breath vs. intrusive thoughts would begin. You’d think that by now I’d be better at shifting my focus, but meditation is always a work in progress.
Tuesday was my 3-D mammogram. That’s the one that verifies that I’m still in remission from breast cancer. Oooo, just a tad bit anxiety-provoking, but since I had seen my oncologist not even two weeks before and he’d already checked me out, I wasn’t overly frightened. I admit, it didn’t help that I couldn’t bring my husband for support (hello, COVID), but I felt positive going in.
And everything looked good. For that day it calmed my scanxiety.
But by Tuesday evening, I was frightened again.
This had ceased to be about breast cancer. Now it was all about my heart. I mentioned in a previous post that I’d been having little “heart episodes”. My blood pressure monitor kept signaling “irregular heartbeat detected” and my heart rate monitor would show funny spikes when I was working out. The app I was using for measuring heart rate variability (HRV) would show heartrates up to crazy numbers like 262bpm, and from time to time I’d get heart palpitations.
To complicate matters, the Herceptin I had been given for my triple-positive breast cancer is known for its cardiotoxicity and there are heart-related side effects associated with the endocrine therapy that I’d been taking for the past three years.
But on top of that, my heart would pound when I got anxious. No matter what I did, I couldn’t ignore it–I could hear it. And that pounding made me even more anxious.
That sounds like a never-ending loop right there.
Somehow I made it to Thursday and my cardiology appointment. The mere thought of having a scan that focused on my heart was anxiety-provoking but the medical assistant engaged me in conversation and kept my mind occupied. Even my blood pressure came out as in the 120s/80s (can’t remember the exact number), which was quite normal. She ran the EKG and went to get the doc.
So right now this story is running long, but the bottom line is that my EKG was perfectly normal. The cardiologist, an older man with a gentle voice and pleasant and calm demeanor, asked a lot of questions…and ultimately told me that he didn’t think my heart had issues.
But he suggested that we run a couple more tests: echocardiogram and 14-day monitoring. That way we could rule out anything serious.
And I, the one who hates scans and the anxiety they bring, felt so much relief that he was willing to humor me, so that I would definitely know if those “episodes” I’d experienced were real or not.
I have everything scheduled now. And wouldn’t you know it: I didn’t experience any weirdness all weekend. No perceived skips, no palpitations. I am rarely aware of my heart beating and no longer hear it in my ears.
So I had several days’ reprieve.
Sunday night I felt it again. Let’s see where this goes.
I had mentioned to my cardiologist all those technological gadgets that I had, my blood pressure monitor with irregular heartbeat detection, my heart rate strap that can measure R-R intervals, my watch that has optical heart rate monitoring capabilities. And he said, the new tech has its benefits but it can be inaccurate.
This time of the year is stressful for me because it’s the anniversary of my breast cancer diagnosis. That means it’s time for the scans that determine whether I can continue to consider myself “cancer-free”. Scanxiety, anyone?
This week is going to be a doozie, since I have my diagnostic mammogram on Tuesday followed by a cardiologist appointment on Thursday, the latter of which has become, ironically, the major stressor as I try to determine whether I’m suffering from “cardiac anxiety” or an actual arrhythmia (one of the possible side effects of aromatase inhibitors). To top it off, I get my first COVID immunization Friday, which brings its own stressors since I’m a bit “side effects-shy” these days.
Given all this, it’s a good time to talk about what apps I use the most to help calm my anxious mind. I’ve written about quite of few of them in my “Mindfulness Apps I Love” series, but here are the one I keep coming back to (all have generous free offerings; both Calm and Insight Timer have had major upgrades since I originally posted about them):
Calm This was the first mindfulness app I downloaded and it’s the one I’ve used every.single.day since March 13, 2017. I find the voice behind the app, that of Tamara Leavitt, very soothing. Since I started with it, Calm has added a number of elements featuring voices of celebrities, music, movement, classes, sleep stories, background sounds and other features that I haven’t even used.
What I use most: The curated “Daily Calm” meditations are my do-to first thing in the morning or if I wake up in the middle of the night with troubling thoughts swirling in my head — Tamara’s voice gives me something to focus on and shoos out the scary negative self-talk.
Why I like it: Because all the material is created specifically for the app, I always know what I’m going to get. It’s predictably high quality using a consistent format, and for me, it works. Also, once the meditation is done, the background sound continues and provides a soundtrack for drifting back to sleep or continuing meditation on my own, if that’s what I need. Finally, since this one was my first app and I ended up investing in a lifetime membership, I get access to everything it has to offer. If you’re not ready for such a loyal commitment to this app, you might not have quite as much to choose from.
Insight Timer This app offers a large collection of many meditations, music, classes and whatnot by a huge array of teachers. You need to search around because you don’t always know what you’re going to get, but if it’s out there, it’s in this app. I’ve played around with meditations that I might not otherwise just because they were available to try out. And now new, there are live events that include meditations, concerts, even yoga classes that you can join to help maintain a sense of community–so important at a time when so many in-person venues are closed.
What I use the most: I’ve settled on a handful of teachers with voices and styles that I prefer. Often, I use this app at the end of the day, when I’m trying to clear my head and settle into sleep, but it’s also great for any time when I want some guidance for settling down and am looking for variety.
Why I like it: OMG, the selection! Not only is there just about every type of meditation available (secular, sacred, shamanic and so much more–and now the app allows you to filter out the ones that make you, shall we say, “uncomfortable”), but there is a vast array of languages in which to listen. I speak a specific European language from a small Baltic nation, and yep, Insight Timer has a meditation in it. This is really worth looking into and most of everything is available for free–but donations in support of the app and teachers are very welcome.
Unwind This is an app that I recently reviewed here, and as I’ve gotten more into breathwork and vagus nerve relaxation, it has become invaluable to me. The combination of ambiances that you can select from paired with a gentle guiding voices that cues breath inhales, exhales and holds has made this perfect when I don’t want a guided meditation but I do want something to focus on.
What I use the most: Lately I’ve been opting for the “box breathing” pattern (inhale, hold, exhale, hold). It is perfect for calming my mind without straining my breath. I pair that with the “River Under Bridge” background ambiance that is a nice combo of gentle bird sounds with soothing running water.
Why I like it: Unwind has gotten me out of some anxious moments, specifically too-early wakings brought on by a racing heart. Instead of throwing in the towel and deciding that I’m just going to have to start my day at 4:27am, I’ve been able to lull myself back to sleep; again, the spoken breath cues provide guidance but are unobtrusive enough to allow drowsiness to set it. Additionally, Unwind is ideal for those times of my day that I need to eke out some head space and take a break from work pressure. Even a few minutes is enough to get my breath under control.
MyNoise I posted about this app in late January. It’s the most recent one that I added, but it is amazing! MyNoise consists of sound generators that you can manipulate to your liking, to create unique and changing background sounds for literally just about any mood or need that you can imagine! In addition to the app, there is a website (mynoise.net) that provides similar generators. Both the app and the site offer so much, but when I’m working on my computer, I’ll usually listen through the website since my eyes do better with the large screen.
What I use the most: I tend to prefer nature sounds with running water or else drones and more meditative music. My daughter, who is also a MyNoise afficionado uses the sound of medieval scribes to create an atmosphere conducive to doing college work remotely.
Why I like it: S P A C E. MyNoise creates space by masking unwanted ambient noises (busy street, noisy neighbors, etc.) and thereby provides breathing room and headspace. I have used this for mental breaks throughout the day, or for times when I feeled overwhelmed and need help staying present. There are no discernable loops in the sounds and because each sound generator is made up of different elements that can be manipulated by sliders, you literally can create a totally custom sound environment. It has to be experienced to be believed and it’s well worth experimenting with.
So, these are the four apps that I’ll be working with a lot this week as I make my way through scans, tests and immunizations. Each app has their own little something to contribute to maintaining my peace and I appreciate the portability of having such effective soothers in my hand, on my phone.
It was just few days short of four years from my diagnostic mammogram, the one after which I was told I had triple-positive breast cancer.
If you or someone you love has been through this experience, you know the drill: surgery, chemotherapy, radiation, maybe monoclonal antibodies, endocrine therapy. Yours may come in a different flavor, but the dish is the same, give or take.
Last Thursday, following three years of endocrine therapy (two of tamoxifen and one of letrozole [aromatase inhibitor]), I called it quits, with my oncologist’s permission. The side effects of the letrozole became too much for my joints, my brain, my intimate relationship, and possibly even my heart. My doc said he knew it when he saw me and agreed that enough was enough.
Keep in mind the song that all of us cancer folk sing: “everyone’s experience is different.” Based on my personal situation, and after a medical consult, this was the right decision for me.
I wanted to know what to watch out for, so my doc said:
1. Unexplained weight loss 2. Persistent cough 3. Neurological issues (i.e., seeing things that aren’t there, blurred vision, etc.)
Obviously, there are other signs of cancer recurrence, but those are what my oncologist wanted me to be particularly wary of. And then he noted that he couldn’t remember the last time one of his HER2+ patients had a relapse, so effective is the Herceptin that we’re given. But it has heart risks.
Since I’ve been off letrozole only a few days, I’m still experiencing most of the side effects–it will take several weeks to shake them.
I almost don’t know what to do with myself, and I’d be beside myself with joy if it weren’t for a possible heart arrhythmia (!) that I am experiencing. I’ve already scheduled an appointment with a cardiologist.
Yeah, I’m miffed that there’s always something with cancer. A week prior to my onc appointment I’d been in my car at a traffic light when I felt heart palpitations, sort of–and then I started seeing dark spots, like you do before you faint. The episode passed, but I had been having those brief palpitations for months, minus the spots. Maybe once a day? Maybe less.
And over a year ago, I went in for a regular health check-up, during which time the nurse practitioner checked my vitals and noted that there was some irregularity in my heartrate.
Just like with my cancerous lump, I waited, thinking would go away. But chemo and especially Herceptin are cardiotoxic, and aromatase inhibitors have been associated with heart arrhythmias. So just as soon as I got off the cancer carousel, I’m getting on the cardiac one–until I’m able to rule out problems.
I have both a 3-D mammogram and an EKG next week, and I’m way more worried about the EKG. Who would have expected that from a breast cancer survivor?
In case you’re wondering why there’s all this mindfulness stuff on a cancer blog, here’s a reason: a recently published article in Science – Translational Medicine (Perego et al., 2020) provides laboratory evidence for the benefits of reducing stress levels for cancer survivors. It has to do with the effects of stress hormones on cancer recurrence.
In this study researchers looked at the cancer cells that are sometimes pushed into dormancy by treatments like chemotherapy. Cancer recurrence may be a result of such cells being activated again at some point in the future.
Perego and colleagues were able to recreate such dormant cancer cells in the lab, then found that they could awaken them again using neutrophils, a type of white blood cell that, under certain circumstances, can be harnessed by tumor cells to aid in their proliferation.
Those “certain circumstances” turn out to involve stress hormones. The researchers found that stress hormone + neutrophils = woken cancer cells. The process is a cascade of events: the stress hormones caused the neutrophils to produce S100 proteins, which in turn created lipids, and it was those lipids that caused hibernating cancer cells to stretch and rub the sleep out of their eyes.
Keep in mind that these studies were conducted in petri dishes (for “proof of concept”) and then in mice, which does not equate to eliciting the same response in humans. In fact, the connection between stress and cancer is still inconclusive in human studies, partly because in the past researchers have noted that some of the coping mechanisms that humans use to deal with stress (smoking, drinking, overeating, etc.) may be the more important culprits that lead to cancer.
Nonetheless, Perego and colleagues were able to show that stress and neutrophils may form a path by which dormant cancer cells awaken in humans, leading to cancer recurrence, and this opens the door to more directed future research. Note, this is certainly not the only way that cancer can recur, but it provides an opportunity to develop drugs that can break the cascade and thereby prevent recurrence in some cancer survivors.
To be clear, this doesn’t mean that if a cancer survivor is stressed out their cancer will definitely come back, because there are a number of intermediate steps that need to take place within that cascade, but this is still a good reason to practice stress-reduction techniques. It might help you remain cancer-free.
If you have access to a university or hospital library, you can look up the original research article using the following PubMed citation (links to abstracts below; once the free full-text PMC version is available, I will link to it here):
Perego M, Tyurin VA, Tyurina YY, Yellets J, Nacarelli T, Lin C, Nefedova Y, Kossenkov A, Liu Q, Sreedhar S, Pass H, Roth J, Vogl T, Feldser D, Zhang R, Kagan VE, Gabrilovich DI. Reactivation of dormant tumor cells by modified lipids derived from stress-activated neutrophils. Sci Transl Med. 2020 Dec 2;12(572):eabb5817. doi: 10.1126/scitranslmed.abb5817. PMID: 33268511.
ZenViewis a sweet little app that has been around for a number of years–I downloaded mine way before I even considered breast cancer as a possibility in my life. Note: I use the iPhone app and cannot recommend an Android version.
ZenView is designed to offer you a respite from a hectic day and it accomplishes this very simply. It provides you with a soothing nature image and the ability to create raindrops in it, as if you were looking into a puddle.
The interface is easy to figure out. Click on the little cross at the bottom right of the screen to bring up a minimalist menu. You can chose from a variety of “themes”, which are basically background images (8 free and 8 with a paid upgrade). Then select the type of rain you’d like: “soft sprinkle”, “light shower”, “heavy storm” and even a “clear sky”, so you can place raindrops on the image with a fingertip and watch the ripples fan out.
If the provided images don’t suit your fancy, you can use your phone’s camera and get a calmer, rainy-er view of your world through its lens. I’ve found that this is a great way to quickly put some space between myself and a real-life stressor.
The raindrop sounds feel immersive, perfect for taking me away from the stress du jour, no matter what rain intensity I choose. And the sounds can be turned off completely if that’s what you need at the time.
I used the free version of ZenView for years and only recently unlocked the premium themes–I was completely satisfied without them, which is one of the loveliest things about this app: the free version is quite enough.
Ultimately, I upgraded to support the developers, particularly since the cost was only $0.99. Given how much I’ve used this little app over the years, I felt that it was time.
I would encourage you to try this out. It’s not a complex app, but it delivers what it promises: a zen view of the world.