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What’s All This, Then?

“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.

“Healing Bath”: A Body Scan with Visualizations

As a visual person, I have days when my “mind’s eye” has difficulty focusing during meditations. For those times, listening to guided visualizations is my best option for a calming tool.

Additionally, body scans are excellent pre-bedtime wind-downs. So when I recently heard of a great visualization that includes a body scan, I wanted to share it here.

Your private pool can be anywhere you want, even indoors. Source: https://pin.it/4UeEa1U

This one is based on a “healing bath” visualization that was presented by an MSW/Oncological Therapist who leads Friday morning meditation at my cancer center. Putting the focus on vivid visuals and including your other senses fills your awareness with rich imagery that works so well to soothe an overworked nervous system. While this will not be an auditory experience, use your imagination as you read this to paint yourself a picture of a safe, soothing space that you will remember.

Here’s the basic imagery (add details that resonate with you): you arrive at a beautiful natural location, walking down a path surrounded by lush greenery, wearing a luxurious fluffy robe and cushy slippers. As you follow the path, flowery fragrances waft on a gentle breeze that carries bird songs to you. The sun is at a height most soothing for you; for me, it is early morning with a mist in the air. Bright enough to see everything, but imparting a feeling of safety and privacy.

As you continue down the path, it opens up into a small secluded beach with a round pool of water, clear and sparkling; part natural pond and part constructed, with beautiful white stone steps leading into it. Surrounded by flowering plants, it invites you in.

Create a secluded place for yourself. Source: https://pin.it/3j88oEw

You feel the sensation of the fluffy robe and slippers sliding off of you as you leave these items by the entrance to the steps. Then, you dip the toes of one foot into the water and find that the temperature is perfect for you. Notice the sensation of the warm water as you step onto the stone stairs with both feet, holding onto a sturdy railing. You stand up to your ankles in the pool and sense the difference in the temperature between the misty air and inviting water.

Take two more steps down and the water slides up to your calves, soothing your lower leg muscles. Then step further in as the water line slowly travels up past your knees and halfway up your thighs, so that most of your legs are submerged in the placid, warm pool, now feeling more like a bath.

The bottom of the pool is easily visible through the clear water. Unhurriedly, take a few more steps down as your toes reach the white sandy pool floor and the water rises up to your waist, enveloping your lower body in warmth.

Feel the gentle support of the water.

By one side of the pool is a smooth sculpted stone bench to which you glide, feeling the slip of the water against your skin as you move, drawing the tips of your fingers across the pool’s surface, leaving gentle streaks as you go.

As you lower yourself onto the seat, sense the warmth rise up your torso and arms, traveling up as you settle down. The bench is deep enough for your body to submerge but comfortably keep your head out of the water.

The soothing water supports you as the seat cradles your body. Rest your head on the side of the pool – the edge is sloped and comfortable. Then listen. What do you hear? Sweet songs of birds? The meditative buzz of gentle honeybees that flit among the flowers? Waves on a faraway beach?

Can you smell the fragrances of the flowering plants that surround you? As you breathe, as your chest rises and falls, feel the water glide around you. Warm, secure, safe, secluded. This pool is whatever you need it to be for you to feel nurtured and loved.

As evening falls, lights illuminate the pool. Source: https://pin.it/2KpwRO8

Stay here for as long as you like, watching light sparkle on the surface of the water. If you stay until evening, warm lighting illuminates the pool and surrounding plants, dispersing dark shadows and bringing a sleepy tranquility into the area.

Finally, when it’s time to return to present world, lift yourself out of your seat and glide back to the stairs, keeping yourself submerged to your shoulders until you take a hold of the handrail. Slowly, slowly release yourself from the pool, noticing the sensation of air on your skin as you emerge, feeling the waterline move down your body as you climb the steps.

With the final step, you leave the pool and take up the fluffy, soft robe waiting for you, wrapping yourself in it. Slip your feet into the cozy slippers. Your body dries quickly. Make your way up the path. And although you leave this magical space behind, it is always available for you whenever you want to return.

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If you are uncomfortable with water or if the visualization keeps bringing in disturbing images such as a very deep pool, dark water or something foreboding lurking underneath the surface, or it feels constrictive or claustrophobic, substitute a sparkling mist or a golden light for the water. You can still feel the body sensations as you enter into the pool. There are no rules here, it is your safe space and you can set it up as you please.

Finally, to bring this from a visualization into reality, create a real-life pool for yourself in your bath, with ample tealights, a soundtrack of nature sounds or gentle music and water temperature that is right for you. Feel your arms and legs float, prop up your head with a towel on the side of the tub. Breathe deeply. This is a perfect way to end the day and prepare yourself for a restful slumber.

Protection Against Doxorubicin’s Cardiotoxicity: Exercise?

One of the strongest chemotherapy drugs used for breast cancer is doxorubicin, a drug in the anthracyline family that you might know as Adriamycin. It’s called “The Red Devil” due to its bright red color and tendency to temporarily dye the bodily fluids of its recipient red, but also due to its toxicity.

While it is highly effective, its use is limited by its potentially serious side effects, including damage to the heart. According to Drugs.com, “[b]ecause of its heart toxicity, doxorubicin has a maximum cumulative dose that can be given to each patient. The higher the total dose you receive over time, the greater your chance of heart side effects.”

Doxorubicin is a highly effective chemotherapy, but carries with it a considerable risk of heart toxicity.

There has been interest in discovering other drugs that can decrease the cardiotoxicity of doxorubicin, particularly since in addition to breast cancer, it is used against a variety of other cancers.

But as with so many things cancer-related, the drugs given to protect against chemotherapy side effects themselves have side effects, so it’s useful to explore other means of achieving protection from the toxic effects of doxorubicin.

Can Exercise Help?

In a webinar for the American College of Sports Medicine (ACSM) that I attended on May 18, 2023, University of Florida, Department of Applied Physiology and Kinesiology researcher Dr. Ashley Smuder and her lab presented research about the protective effects of exercise on the heart and muscle doxorubicin.

Importantly, Dr. Smuder’s lab was able to demonstrate that exercise-trained rats who were then given doxorubicin showed a decrease in the amount of drug that accumulated in the heart and diaphragm compared to sedentary rats, echoing the results of Parry and Hayward (2015, Am J Physiol Regul Integr Comp Physiol). Those results had suggested that exercise didn’t diminish and even increased the amount of doxorubicin that made it to the cancer tumor while decreasing the amount of the drug that went to the heart (left ventricle) and diaphragm.

Exercise keeps rodents healthier, even under a punishing chemotherapy regimen.

While the actual mechanism of this protective effect is still being researched, once again these studies show the benefits of exercise in a cancer situation.

Additionally, a doctoral student in Dr. Smuder’s lab, Brendan Nguyen, reported on work that he’s done showing the differences of exercise on fat mass and lean mass in rats administered doxorubicin using the same infusion schedule that a human patient would received (4 doses, 3 weeks apart). There were four conditions: (1) a sedentary group that received saline injections, (2) a sedentary group that received doxorubicin, (3) a moderate-exercise group that received doxorubicin, (4) a high-intensity exercise training (HIIT) group that received doxorubicin.

  • Moderate exercise: rats ran on a treadmill 3 days/week at a speed of 30 meters/min for 60 min/session.
  • HIIT exercise: rats ran on a treadmill 3 days/week, four 4-min bouts at 45 meters/min with 3 minutes of active recovery in between the bouts.

Not surprisingly, the exercise training had a significant effect on the body composition of the animals. Sedentary rats in both groups had an increased risk of obesity. Both groups of exercising rats (both moderate exercise and HIIT) saw a decrease in fat mass during this time and were able to avoid doxorubicin-induced cardiorespiratory weakness. Also, the HIIT exercise animals showed a significant increase in lean mass in addition to the drop in fat mass.

For reliable protection from the negative physiological effects of chemotherapy, exercise is still your best bet.

These findings in rats reflect similar results that have been obtained in humans (Battaglini et al, 2014, World J Clin Oncol; Lee et al, 2019, BMC Cancer; Lee et al, 2021, Support Care Cancer). Brendan noted that particularly HIIT exercise “may prevent unfavorable changes in body composition” compared to a sedentary condition.

The take-home message here remains the same as it’s been in my other posts. If you don’t currently exercise, start now. And then don’t stop. It’s easy to keep laboratory rats active and fit, but humans find many reasons not to challenge themselves with physical activity. If you needed a reason, these studies provide a little encouragement to find your favorite movement modality and make exercise a life-long habit.

REFERENCES

Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, Hackney AC (2014) Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature. World J Clin Oncol, 5, 177-190. https://doi.org/10.5306/wjco.v5.i2.177.

Lee K, Kang I, Mack WJ, Mortimer J, Sattler F, Salem G, Dieli-Conwright CM (2019) Feasibility of high intensity interval training in patients with breast Cancer undergoing anthracycline chemotherapy: a randomized pilot trial. BMC Cancer, 19, 653. https://doi.org/10.1186/s12885-019-5887-7.

Lee K, Norris MK, Wang E, Dieli-Conwright CM (2021) Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy. Support Care Cancer, 29, 6863-6870. https://doi.org/10.1007/s00520-021-06294-7.

Parry TL, Hayward R (2015) Exercise training does not affect anthracycline antitumor efficacy while attenuating cardiac dysfunction. Am J Physiol Regul Integr Comp Physiol, 309, R675-83. https://doi.org/10.1152/ajpregu.00185.2015.

Smuder AJ, Nguyen BL (May 18, 2023) Cardiorespiratory muscle response to chemotherapy and exercise. ACSM’s From Around The Field webinar.

Can Meditation Fight Cancer?

While it seems like a pretty fantastical concept, a group at the University of California San Diego just received a five-year, $10M grant to examine just that.

Specifically, the InnerScience Research Fund will support ongoing research at UC San Diego’s School of Medicine to determine the biological effects of meditation. Researchers led by Dr. Hemal H. Patel (Dept. of Anesthesiology) are exploring whether meditation can modulate the progression of serious illnesses.

From the UC San Diego Today press release (May 16, 2023):

Researchers are gathering a variety of information from a large group of participants.

“As part of a continuing study entitled “QUest to ANalyze a Thousand hUmans Meditating,” or QUANTUM, Patel and his team are assessing the impact of meditation on nearly 2,000 individuals undergoing intensive meditative experiences. The goal is to capture a depth of unbiased information from a large cohort of healthy and non-healthy individuals to gain insights into the impact of meditation.”

Study participants are contributing a plethora of biometric data obtained via wearable technology, “including heart rate, heart rate variability, sleep, activity and more. That data is then coupled with health survey results and “omic” studies being conducted on blood, microbiome, urine and tears.” Brain activity has also been measured and analyzed.

Perhaps the most unexpected statement in the entire press release was the following: “Early analysis is showing promising results from meditation in impeding serious illnesses such as cancer.”

This is quite an announcement coming from a highly-respected research institution, so I am particulary intrigued.

It would be wonderful to find that the benefits of meditation go far beyond improving one’s sense of calm — lotus position optional!

On the one hand, it’s not difficult to believe that harnessing the mind through meditation could have a dramatically positive impact on one’s health. As I reported in an older post, researchers have elucidated the biochemical pathway by which stress can lead to cancer recurrence in breast cancer survivors. So if we’re able to do the opposite–inviting in a sense of peace and keeping stress at bay–it stands to reason that we affect disease progression. After all, we’ve known for a long time about the benefits of meditation on one’s mental well-being, why not one’s physical health too?

On the other hand, it’s important to understand that meditation alone should not be considered a treatment or cure for cancer. But as my last post on complementary medicine pointed out, cancer patients are increasingly turning to practices such as meditation to help them navigate the cancer experience as they undergo conventional treatment. The added benefits of helping halt the proliferation of a tumor would make meditation an important adjuvant therapy.

This is one story that I will be keeping a close eye on!

“Not Going It Alone”: Complementary Cancer Therapies

With as much sophisticated research as has been done on cancer, it still remains a confounding disease and much of the treatment may seem to be, for lack of a better word, medieval.

So it shouldn’t seem surprising that cancer patients also reach out for less conventional therapy to help themselves through the treatment process.

First, a clarification of terms used in this post:

Acupuncture is utilized as a non-standard treatment (for those who can take more poking)
  • Conventional medicine: chemotherapy, radiation, surgery, immunotherapy, etc., prescribed by your medical team.
  • Complementary medicine: non-standard treatment used in conjunction with conventional treatment; also called Integrative Medicine.
  • Alternative medicine: non-standard treatment used instead of conventional treatment.

Therefore, generally speaking, what distinguishes complementary from alternative medicine is whether it’s used with standard medical treatment.

According to a study (Crudup et al., 2021) that was presented at the 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), 73% of breast cancer patient participants stated that they employed complementary therapies in their treatment. However, while oncologists were supportive of such therapies, they were not aware of the extent to which their patients utilized them and thought that only 43% of their patients did.

Patients get more benefit from spiritual practices than most oncologists realize

Furthermore, oncologists felt that counseling, support groups, exercise, etc. were the most effective non-standard therapies, in contrast to patients who found great benefit in meditation, mindfulness and spiritual practices. While two-thirds of both patients and oncologists felt that complementary medicine improved quality of life, a majority of patients also felt that it improved their outcomes.

Wayne Jonas, MD, a co-author of this study, says: “Cancer is a complex disease that affects every component of a patient’s life. While conventional medicine is effective for curing disease, it can fall short in helping patients heal. Patients are turning to these therapies to look for hope and to improve their quality of life and well-being after diagnosis… .”

What types of therapies do these include? The website “Cancer Health” provides examples of some complementary treatments (see here for an explanation of each):

Acupuncture
Aromatherapy
Art Therapy
Biofeedback
Cannabis
Herbal Therapies
Labyrinth Walking
Massage
Meditation
Music/Dance Therapy
Qigong
Spirituality
Tai Chi
Traditional Medicine (Ayurvedic, Chinese, etc.)
Vitamins and Supplements
Yoga

[This list is by no means exhaustive.]

I used a number of these complementary therapies myself and can attest to the important role they played in my recovery. As Dr. Jonas points out above, conventional treatments “can fall short in helping patients heal” [emphasis mine], whereas non-standard therapies seem to focus on that aspect.

I believe that these additional therapies, particularly more spiritual ones, are what give us hope throughout the cancer experience. Patients should be encouraged to seek out additional, complementary therapies to help themselves move through treatment, fully supported by their oncologists and ideally also guided by them.

Did you rely on complementary or alternative treatments to help you through your cancer journey?

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REFERENCES

Original Research

Abstract for presentation:

Crudup et al. (2021) Awareness, perceptions, and usage of whole person integrative oncology practices: Similarities and differences between breast cancer patients and oncologists. Presented at 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), https://meetings.asco.org/abstracts-presentations/200685

Published research article:

Crudup et al. (2021) Breast cancer survivorship and level of institutional involvement utilizing integrative oncology. J Clin Oncol,  39, no. 15_suppl. e18588,
https://www.doi.org/10.1200/JCO.2021.39.15_suppl.e18588

Synopses

The ASCO Post Staff (June 7, 2021; updated June 15, 2021) Use of integrative medicine by patients with breast cancer. ASCO Post, https://ascopost.com/news/june-2021/use-of-integrative-medicine-by-patients-with-breast-cancer/

Tien C (June 28, 2021) Oncologists Underestimate the Number of Breast Cancer Patients Who Use Complementary Medicine. Cancer Health, https://www.cancerhealth.com/article/oncologists-underestimate-number-breast-cancer-patients-use-complementary-medicine

Descriptions of complementary therapies

Living with Cancer: Complementary Therapies. Cancer Health, https://www.cancerhealth.com/basics/health-basics/complementary-therapies

Mindfulness 101: Noticing the Qualities

The main reason why I started a meditation practice was because I had been diagnosed with breast cancer and was, to put it mildly, freaking out.

As a naturally anxious person, the diagnosis blew the roof off my ability to cope and plunged me into a nightmarish situation. Anyone who’s ever dealt with severe anxiety will tell you that nothing is more important than making it stop.

Over the years, my anxiety gathered enough power that it was able to blindside me. Cancer anxiety practically wrecked me.

When my radiation oncologist recommended mindfulness meditation, I felt empowered by the thought of gaining control of my runaway anxiety without the need for medication.

I was hoping meditation would enable me to sit in peace in the midst of chaos. But I imagined that as feeling no stress, as in, being numb to anxiety-provoking stimuli.

That simply doesn’t exist. I wanted to not experience any stressful situations, but there is always stress. We can’t change that. Mindfulness meditation was only going to help me change the way I reacted to it.

So here I am, more than six years after initally starting a daily meditation practice and guess what? I still have stress, I still feel anxiety.

However, what did change is that I can define it now. When I become aware of agitation and anxiety, I know to pause and bring attention to how it manifests in my body.

What does it feel like? Tightness, heat, rapid breath?

Where does it show up? Face, temples, chest, stomach?

Is there a color or sound or smell associated with it? Does it have a “texture”?

Does anxiety have an odor? Next time stop and take a whiff.

I can relax my muscles, sink into the earth, breathe deeply and notice the qualities of anxiety. By pulling apart what is happening, I slow time down. Instead of being hit by a locomotive full force, I walk around the train cars. I can notice how I feel as I pass through the experience.

Is it pleasant? No. Does it always work immediately? No. However, I can see it coming, and as a result, I relax into it. It is the awareness of the anxiety that helps me through it, not a numbness to it. This leads me to acceptance of the situation instead of bracing against it.

On one level, it’s a little discouraging to still be dealing with the unsettling nature of stressors. But I am heartened by the empowerment that mindfulness offers. I have evolved enough that I know I don’t have to go back to being thrashed by the whirlwind. I can sit inside it and watch it swirl and pass through. Every time I do this, it gives me more confidence for the next time.

Is this something that might help you too?

Things I Wish I’d Known About Breast Cancer, Part 2

This post continues what I started in the last post…a few things about breast cancer that I wasn’t aware of at the time of my diagnosis. Knowing the following would have made things a little less stressful:

1. Lumpectomy is a relatively uncomplicated surgery. I wish someone had explained this to me because I was a total wreck going into surgery (which happened to be the only surgery that I had ever had up to that point, making everything 10 times worse). Although I had decided against a full mastectomy, I was still so afraid of what a lumpectomy would entail, what I’d look like and how long it would take me to recover from losing a chunk of flesh.

The reality was…I was back at work the next week. No drainage tubes, no need for heavy analgesics — just a couple of ibuprofin the night after surgery because skipping coffee that morning resulted in a headache, but that was it. It was even hard to tell that I’d had my lump excised. Wish I could go back to my earlier self and tell her not to worry.

Stethoscopes are emotionless. Oncologists can seem to be too, but that’s by design.

2. Doctors are not in a hurry to give you good news. I think there’s a general feeling among medical professionals that there’s so much that can go poorly during cancer treatment that your doc isn’t going to go out of their way to pump you full of optimism. They probably practice keeping an emotionless face as they deliver all sorts of news, both good and bad. As a patient, however, I watched every flicker on my oncologist’s face for an indication of how things were “really” going. I feared that there was something he wasn’t telling me.

It wasn’t until perhaps a year or so later when I was expressing my fears to him about possible abnormalities inside my body that he uttered the phrase, “but you have your health”…and I was taken aback because I had never heard him sound so positive. It was almost a shock to hear him confirm that I was actually considered healthy.

3. Don’t expect things to be the same as before. Accepting that part of your life has changed will make it much easier to go on. This took me a while to appreciate because I was expecting to get back to doing and feeling everything the same as before my diagnosis.

But chemo (and eventually, age) pushed me through menopause, and I had to come to grips with, say, a high-intensity interval workout requiring more recovery time and that I had trouble remembering people’s names. Once I got to that point of acceptance, life after cancer treatment became easier, although it did take a number of years to get there.

4. Hair takes a while to grow back in. The reason I created posts with photographs that illustrated the cancer journey that my hair went through (here and here) was because I could not find good photos on the internet documenting the process. I did see images of a woman a few weeks after stopping chemo with little stubs already visible, but that was not my experience and it made my anxiety over my slow regrowth even worse.

Walking around with no hair was getting old and I was getting more desperate by the day to see evidence of sprouts!

If you’ve ever googled your chemo drug name + “hair loss”, you understand the fear: the first search result is usually a law office gathering info on behalf of cancer patients whose hair never grew back!

It took a number of months before my folicles woke up and actually started growing. I remember the moment that I finally saw growth on the front of my head and it was as if the heavens had opened up and divine light poured out onto me. Seriously. I would have avoided a lot of stress if someone had just told me that it’s gonna be a while.

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Ok, ok, to be fair, my oncologist did urge patience with the regrowth but I was a jumbled mess of nerves and was feeling overwhelmed. All the internet propaganda about both (1) other women having much faster regrowth, or (2) other women never getting their hair back terrified me. Note to self: when feeling desperate, stay off the internet!

Things I Wish I’d Known About Breast Cancer, Part 1

Cancer, perhaps more than any other disease, has a formidable reputation that precedes it. Because of this, cancer “lore” can affect your expectations of treatment effects and anticipated prognosis if you are unfortunate enough to receive a diagnosis.

There were a number of things that I didn’t realize about breast cancer that might have made my experience, if not better, at least slightly less harrowing. Here are a few of them, in no particular order:

1. Breast cancer research remains more highly funded than that any other cancer (source: 2019 Northwestern University estimate) and is therefore the best-studied type of cancer. As a result the treatment plan is solid. While this does depend somewhat on the type of breast cancer you have (Triple-Negative, Triple-Positive, Hormone Receptor-Positive, Inflammatory, etc.), the fact remains that there is great interest in “saving the boobies”.

We are living in an era where research in breast cancer is churning out valuable findings at a break-neck pace.

Your treatment plan has likely been well-tested with ample positive outcomes. Combine this with the tendency for this cancer to be diagnosed at earlier stages due to the relative ease in finding a tumor (I mean, you can feel the lump even if it’s not very big), survival rates tend to be very good. Understandably, that might not be very comforting at the time that you’re hit with the news that you have breast cancer, but it is a blessing that you’ll appreciate later.

2. Getting breast cancer is not your fault. I struggled with this one for a loooong time. If you’ve read some of my earliest posts, you know that I not only had a hard time getting my head around my diagnosis, but also a lot of anger about everything I did that was considered “protective” that seemed not to make any difference.

The reality is, as much as we do know about cancer, there’s still a lot we don’t, which means you can be doing everything right — even “perfectly” — and still be diagnosed with breast cancer.

The message I got from cancer-prevention campaigns was that there was so much you could do to avoid the disease. I checked off all those boxes and thought that I was at very low risk. I was “the fit one”, the vegetarian, a dutiful breast-feeding mom allowing myself no indulgences — the last person you’d imagine this happening to, but it did.

I felt ashamed about the diagnosis, even feared that I would be accused of lying about my healthy habits. I was terrified that my healthy lifestyle had somehow backfired. While this sounds ridiculous now, feeling so out-of-control about my own health was demoralizing and depressing.

3. A healthy lifestyle goes a long way in making recovery easier. While I felt dejected about not being able to avoid breast cancer, my exercise and dietary habits helped me recover from treatment side effects faster and not gain weight afterwards. And as I learned later, by maintaining an active lifestyle, I was significantly decreasing my chances of cancer recurrence. I wrote about those findings in this post.

So all my efforts were not for naught. Word to the wise: if you don’t exercise regularly, start now. If you do exercise, keep going!

In the darkness I found a little light.

4. There is light in dark places. I must stress that cancer isn’t some “great” thing that happens to you and it carries with it big side effects and an ever-present risk of death. I lost two friends to breast cancer who were both diagnosed about the time that I was and they were far too young to die.

But given that I had to go through this, I had the option of “sink or swim” when it came to how I would view my experience. Eventually I found the light in the darkness of the cancer tunnel, but it did take a number of years and many ups-and-downs before I was able to appreciate the lessons that the disease taught me: being able to accept and live with uncertainty, identifying a clear purpose in my life, finding gratitude in small things, even coming to grips with my own mortality. These lessons were difficult but also valuable, and I admit that I wouldn’t have learned them if I had not gotten cancer.

Perhaps some of the most important of these were identifying that I had suffered from anxiety for a good part of my life and understanding how it had shaped my decisions. Yes, it took cancer for me to realize all that! This led to incorporating mindfulness and meditation into my daily routine.

And that is a very positive thing indeed.

“Detached”: Time-Out in Third-Person

As an addendum to my post where I wrote about using third-person language in meditation to help keep distance between yourself and your thoughts, I wanted to revisit this method for everyday life.

While in that post I alluded to using third-person descriptions on stressful days, it’s really worth emphasizing the utility of creating space throughout the day.

To sum up that post, I mentioned a mindfulness technique suggested by meditation teacher Jeff Warren in which when we find ourselves being swept away in thought, we describe what’s happening in “third-person” language and play the role of an observer.

Observe…make space…gain perspective.

But as I said in that post, why limit that to meditation sessions? In fact, you could argue that it is even more important to bring that type of gentle detachment to the things that ordinarily set us off in our daily lives, whether it be with family, at work or anywhere.

I would say that so much of my anxiety has stemmed from an inability to maintain perspective about the trigger. Noticing when I’m getting carried away and then describing the situation as something that is happening to another person — similar to the way a newcaster might report on an event in a calm, informative manner — helps loosen its grip on me.

The ability to step back and detach from the situation is kind of the name of the game in terms of reducing stress levels, isn’t it?

By narrating the circumstances around your stressors, we make space: “FranticShanti felt a little ill when she saw that the letter in her mailbox was from her landlady. She expected this to be about a rent increase…and she was right. Another $200 per month.”

Third-person language gives us the space we need to tackle our stressors without getting pulled into them.

That telling offers some space. It doesn’t change the situation, simply presents what’s happening in an unemotional manner. Then following up with some trouble-shooting helps soothe my agitation: “This will require a review of her finances, but as she calculated with last year’s rent increase, she can still absorb this additional amount. Things will probably be okay. She takes some deep breaths and feels into her hands and feet.”

Not only can you calmly describe the situation, but you can describe yourself engaging in self-soothing techniques as you work out your next steps.

It is quite effective in slowing down racing thoughts, particularly if you’re in a place where you can speak out load, as hearing yourself describing things can be even more grounding.

As with other simple grounding techniques, this may seem a little contrived or simplistic, but it might be just enough to bring you out of your head and into the here and now — cool, calm and collected.

Such a Fragile Life

I’m not going to post the post I’d written for today.

Something else came up and it really made me think about how we are teetering on a slim ledge between “everything’s ok” and “the end is near”.

Last Wednesday, I cut the inside of the roof of my mouth in the soft palate. Or maybe it was a burn? I didn’t pay much attention to it because this happens from time to time, it’s not that big a deal and it seems to heal quickly.

Except this time it didn’t. Granted, I ignored it a tad too much and wasn’t as careful as I should have been about what I was eating. I felt loose skin rub off around that area.

In a second, everything can change. [Note: this is not my car.]

It started hurting more and eating became more painful. At night, my mouth dries out even when I’m sleeping with closed lips. My tongue feels like sandpaper against my palate and because of where the wound was, my tongue was irritating it.

Friday, I realized that if I spoke a lot without a break, my tongue would abrade that sore area even more. Saturday, I told myself that I should be doing warm salt water rinses, but kept forgetting to do so.

Sunday, my head hurt upon waking although the area felt kind of better? But when I tried eating and drinking as normal (albeit avoiding that side of the mouth), the pain seemed worse.

Or maybe it was my perception of that pain? For me, it’s so hard to tell. I vacillate between ignoring a dangerous situation and imagining the possible worst; it feels like I could talk myself into/out of anything.

Before I was diagnosed with breast cancer, I had been aware of the lump in my breast for six months, but kept telling myself not to freak out and that it would probably go away on its own.

Maybe it’s really bad, maybe it’s not bad at all…I dunno…

Spoiler: it didn’t, and although the tumor was still Stage I-sized when I finally went to the doctor half a year later, it had already invaded the tissue outside the milk duct in which it originated. [To be fair to myself, there was more to that decision, which I won’t go into here. I wasn’t a total idiot about it.]

And then after completing all of my chemo rounds, one of my fingernails looked like it had a bubble underneath it…which I ignored for several days (actually, it became impossible to ignore because the pain was increasing), figuring I’d wait because it was probably just my nail coming off, which sometimes happens with chemo.

Except that it wasn’t. It was an infection. But instead of going to the ER immediately, I waited another night because it was the weekend and I figured I’d call my oncologist in the morning.

That night was worse than any night of my life. I barely slept because my hand was on fire and in the morning there was red line running down from my finger into my wrist.

At that point, I was probably closer to death than I had been throughout my entire cancer experience.

My point is, I was able to “reason away” any immediate responses and ignore striking red flags for fear of blowing things out of proportion. I didn’t want to look like a hypochondriac. It was hard for me to fathom that the situation was as dangerous as it ended up being.

Here for only who knows how long…

But our lives are really so fragile. After going through cancer, I realized that something could be going on inside my body, silently, that could change me irreparably — even kill me — within a very short period of time. And it could be happening right now.

What a tenuous hold we have on our existence here. How often do we forget that? And why aren’t we more careful with ourselves?

Such a short tenure on this Earth. Where do we put our energy? Too many spend so much time being horrible to each other and the world around us. And most of us don’t appreciate what we have until it’s too late. Some of us never appreciate it at all.

Take a deep breath, hug the ones you love (that should include yourself) and enjoy this moment.

I’m going to go rinse with salt water…

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A little update: I made a doctor’s appointment for early tomorrow morning, after which I realized — through diligent image googling — that I probably had a massive canker sore. It’s not likely to kill me but it’s doing a good job making me miserable.

And if I’m wrong and it’s something worse…then that’ll be next week’s post.

Creating Space with Third-Person Language

I’ve had some up-and-down weeks this year and have been working on making space in my head to lessen the impact of anxious thoughts.

I recently heard a wonderful suggestion by meditation teacher Jeff Warren (via his Daily Trip on the Calm app) about creating more mental room for yourself. He encourages describing what’s happening in the third person when thoughts come up during meditation.

Like many suggestions to help with mindfulness, this seems surprisingly simple, but so far I and everyone else I’ve recommended it to have found it to be very effective.

Making space is good for more than avoiding viruses…

It goes like this: I am sitting in meditation focused on my breath (or any other chosen anchor) and a thought pops into my mind. I say to myself, “There goes FranticShanti thinking about X topic again”.

Suddenly I feel a *whoosh* as I’m pulled back out of that scenario. And instead, I’m observing myself having that thought. Hearing myself describe the situation as a bystander has a calming effect and creates a sensation of safety and distance.

I’m still staying present and noticing what’s going on around me, but recognizing that this thought is happening to the person who is known as me — instead of allowing myself to get sucked into it, along with all the associated emotions — expands the amount of mental space I have.

It’s kind of like looking through a window at a situation instead of being there in the room with it. Not nearly as scary or immersive.

Looking at things through a protective buffer makes even scary situations less threatening.

Likewise, throughout the day, describing a stressful situation in third person helps us remember that there is always space around us that can serve as a buffer from unsettling thoughts. It can even help us handle anxiety-provoking situations as it also provides an opportunity to describe a potential ‘solution’, as if you were to give a friend some advice on how to deal with it.

Imagine saying, “[Your name] just realized that there’s a deadline they forgot about, so they’re reshuffling their schedule to accommodate the task.” That’s much more productive and grounding than screaming, “AAAAAAAAIIIIIIIEEEEE!!!” in your head.

So, I’ve started using this in everyday interactions when I feel myself getting swept away by worries. It’s been an effective way of bringing myself back into the present, to what is real and actually here, and it serves to reframe what is going on in my life.

This sort of method brings stressors down to a manageable level, allowing for perspective. And we can all use a bit of that.