Month: October 2020

There Goes Another Cancer Milestone…Big Deal

On October 23, 2017, I finished radiation therapy for my stage 1, triple-positive breast cancer. That was three years ago. At that point, I imagined myself being through all the “tough stuff”. I’d already had surgery that March, spent the summer enduring chemo infusions, and then six weeks of radiation in autumn.

October 23rd seemed like a “marker” day. I rang the gong in the radiology waiting room, with all the staff present and smiling. It was a day that I knew I’d remember.

Except that it didn’t end up being a very important milestone. At that point, I didn’t fully realize that the treatment doesn’t really end. I can only say that it’s been three years since I finished chemo and radiation. But the truth is that a few weeks after that I started tamoxifen (surprise!), which came with its own worries. And I still had more than half of my infusions of Herceptin (trastuzumab, a monoclonal antibody) left, which stretched into April of 2018.

I guess next April, I’ll mark THAT as another milestone.

This coming December I can mark a full year of taking letrozole (aromatase inhibitor), which came after two years on tamoxifen. But I’m still supposed to be on that stuff for “a few more” years – it’s funny that my oncologist has not been specific about that. And I’m not very interested in asking, unusual for me.

I really thought I’d have said “goodbye” to all things cancer by now, but its spectre still seems to follow me around.

What once seemed like a very clear treatment plan, a definite path through the cancer jungle, now seems fuzzy and gray. In one of my first posts here, I talked about being able to put everything behind me, with the more time that passed after “finishing” chemo and radiation. Who was I kidding?

When mammogram time comes up, there’s that familiar rush of anxiety, knowing that I’ll be sitting in that comfy robe in the quiet waiting room, pretending to enjoy a cup of tea, but my tummy will be floating and I’ll try to not to think of much. That’s the work of cancer.

When I wake up in the middle of the night with my hand aching and fingers painfully stiff, medication side effects that are deemed, by the medical community, to be “worth it”. That’s the work of cancer.

When I wonder whether my 18-year-old daughter should be doing breast self-exams now. And whether she’s be hurt by whatever “mistake” my body made in not cleaning up some tumorigenic genetic defect. That’s the work of cancer.

So it makes all those “milestones” a little less fun and exciting.

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But I have to be honest — I still note the time that’s passed by. For my breast cancer, the two-year mark is most important, followed by the five-year mark and then the 10-year one. Each year cancer-free makes me more cocky. But the truth is, one “bad” scan, and I’m back to square one: cancer patient. And then I’ll regret not having appreciated those milestones more.

The Magic of the Exhale

If there is one thing that I can point to that has had the most profound effect on my reaction to anxiety-provoking stimuli, and also brought more calm into my entire day, it is deep, diaphragmatic breathing.

Diaphragmatic breathing (sometimes referred to as “belly breathing”) is an effective way to bring air into the lungs than simply inhaling into the chest. As the belly pushes outward, it pulls the diaphragm down, allowing the lungs to fully inflate.

This deep breath, in conjunction with my favorite breathing pattern — Dr. Andrew Weil’s 4-count inhale, 7-count hold, 8-count exhale — is what I call my magic pill. I have found this type of breathing to be very soothing. Dr. Weil based the 4-7-8 pattern on pranayama, an ancient yogic breathing technique, but the benefits are well-supported by modern science (Gerritsen & Band, 2018, Front Hum Neurosci, for example).

Neuroscientifically Challenged presents a short video introduction to the vagus nerve: “2-Minute Neuroscience: Vagus Nerve (Cranial Nerve X)“. It’s everything you never knew you really needed to know about the vagus nerve.

For me, it is the extended exhalation that is key. When the length of the exhale equals or particularly exceeds that of the inhale, a signal is sent to the vagus nerve. The vagus nerve is the 10th cranial nerve, and the longest one, running from the brain down to the abdomen, innervating a number of major organs along the way. The vagus nerve is also a major part of the parasympathetic nervous system (think: “rest and digest”) (Breit et al., 2017, Front Psychiatry).

The extended exhale has been shown to increase heart rate variability (HRV), slow down the heart rate itself and relax the body. HRV “represents the healthy fluctuation in beat-to-beat intervals of a human or animal’s heart rate. … Higher HRV is associated with stronger vagus nerve function, lower chronic stress levels, better overall health, and improved cognition” (Bergland, 2019, Psychology Today).

When I notice that I’m rushing through my day or experience wakefulness in the middle of the night, I have learned to turn my attention to my breath. Regardless of whether or not I’m feeling anxious, I often find myself breathing more rapidly and shallowly (chest breathing). As soon as I become aware of this, I take a deep, diaphragmatic breath and deliberately extend the exhale.

That first deep breath makes me realize how much I needed to slow things down.

That first deep breath is like putting the breaks on a runaway locomotive. It make take several more breaths to fall into that full pattern. I don’t force it — I simply allow each breath to be slower and deeper than the previous one. The sense of grounding feels amazing. I keep a lot of tension in my neck and shoulders, so I take care to release those muscles with each exhale. The result is that I feel a gentle sinking and relaxing.

One of the ways that I’ve benefitted most significantly by taking a “breath break” like this is that it has linked my formal, “on-the-cushion” meditation to the rest of my life. Even after I had established a daily meditation practice, I struggled to bring that same sense of calm into the rest of my day. Breathwork was the missing piece of the puzzle.

This deep breathing slows the overwhelming rush of sensations and provides an immediate connection to “now”, inviting stillness and spaciousness. Noticing my breathing in the midst of chaos exercises mindfulness. All this results in a sense of contentment and well-being.

Who wouldn’t want that?

How Mindfulness Helped Me Enjoy Cleaning

Full confession here: For years (ahem, decades), I disliked cleaning. I understood the importance of keeping things clean and tidy. But I never connected a positive feeling with it. Even as an adult, I would put it off. And off. And then someone would want to stop by and I’d be filled with dread. Never was the disheveled state of my home as apparent to me as when an outsider walked though the front door. Suddenly, I saw everything with fresh eyes, and it didn’t look great.

My approach to cleaning changed when I did one small thing: I noticed that my life was not one big overwhelming mess. It was a series of little challenges. So, too, my home. I stopped looking at everything as a whole. The whole was overwhelming. The whole meant a day spent cleaning and organizing. It didn’t have to be like that.

Just as life is in flux, so is the order in your home. Think of is as a wave, never, standing still. Things fall out of order and then are put back in order. Consistency in effort is what gives music to the dance. So you never have to “miss it”.

When I started looking at the work as distinct items, it was so much easier to take care of things. A small pile of papers. Scrubbing out the kitchen sink. Cleaning three windows.

It was that simple. I stopped thinking about “all the stuff I need to do”. Instead, I thought, “Oh, look! This is done already.” The boost of positivity that I got from taking care of the finite tasks was infinitely rewarding.

Most importantly, I made this a working meditation. My focus was on “now”. Scrubbing this spot of the bathtub. When it was done, I went to another spot. And that way traveled around the bathroom and out to other rooms until I was done for the time being. The rhythm made the day bright.

My personal strategy for cleaning mindfully:

  1. Set a timer for a reasonable amount of time, say, 10-15 minutes — you will quickly find a time that’s right for you based on how much you bristle when it’s time to start. Pick out a manageable “project” (or perhaps several) that you can get done during that time. Start when the timer starts. When the alarm rings, you’re done.
  2. Whatever you are doing, do it with a focus on the present moment. Give your full attention to what you’re working on. This is not the time to worry about what else needs to be done — stay with what you’re doing now, just as you would stay with your breath during meditation.
  3. Decide to do it again tomorrow. That stuff you did today? It’s done and no one can take that away from you, so whatever you do tomorrow only adds to the satisfaction of moving forward. Consistency is what makes this strategy work.
  4. Bring lightness and joy to the task. Play music, run an essential oil diffuser. Mark your success with staying on task by bringing in fresh flowers, even just foliage clippings in a colorful vase. Help yourself feel positive through the process. THIS IS NOT A PUNISHMENT.
  5. Pick up after yourself throughout the day. There is great power in putting things away right after you’re done with them. It feels so silly to even have to write that, but trust me, it’s a useful reminder, and one that I needed until it became a habit. (Who am I kidding? I STILL need the reminder.)
  6. The corollary to #5 is not to procrastinate on starting. If you start now and recycle five papers that you don’t need, there will be five fewer papers cluttering your desk. If you do that again tomorrow, that will be ten. Do it now. I have missed out on so many wonderful opportunities in my life because I put things off, a clean home being the least of them.
  7. Notice how good it makes you feel to invite order into your life.
I feel unsettled simply looking at this image. The disarray elicits anxiety, like I’ve lost something important, with little hope of easily getting it back.

I’ve found that the state of my surroundings is representative of my emotional state. And my emotional state likewise responds to the environment around me. When I was diagnosed with breast cancer, my world crumbled around me, physically and emotionally. Everything felt out of control and my surroundings reinforced that sense of despair. It took months for me to finally get a grip and move past the overwhelm.

Bringing order into my life was like an anchor that helped me recover, in many senses of the word. When I focused on what was good in my world, I spent less time worrying about what was wrong.

I’m betting you have 10 minutes in your day…

Mindfulness Apps I Love: “Unwind”

Disclosure: I was approached by Unwind‘s developer to review their breathing app and offered a free upgrade. I appreciated the suggestion to try Unwind because these days I’m all about breathwork. In addition, upon reading about the app in the iPhone App Store, I was impressed with both the concept and the developer’s sincere responsiveness to user comments. You can find it in there App Store here.

I’ve been using the Unwind app for a number of weeks now. It is a lovely breath-focused app with a number of unique features that I love, customizable and easy to use.

Unwind offers three breath exercises, all of which I which I recognized as science-backed for specific purposes: (1) the “Start fresh” pattern (6 counts in, 3 counts out) which brings oxygen into the body and energizes you; (2) the “Relax & unwind” pattern, great for a relaxation break during the day (4 counts in, hold for 4 counts, 4 counts out, hold for 4 counts); (3) the “Sleep better” pattern, perfect for deep relaxation before bed (4 counts in, for 7 counts, 8 counts out).

The user can pair these patterns with a specific ambiance. An ambiance is a themed background soundscape, and Unwind offers a broad range with options such as Rainforest, Rain on Umbrella, Village Backyard, Open Air Cafe, Japanese Pagoda…including unique ones that I haven’t found in similar apps such as Deep Space, Swimming with Whales, Castle and City Skyline with Ocean. At last count, there were 33, so there’s a flavor for every mood.

Breathing in, the landscape moves up.
Breathing out, the landscape moves down.

Each ambiance has a visual associated with it, and I really like the way the breath is represented in Unwind. In other apps, the breath is often shown as a ball, but in Unwind, it’s the selected ambiance’s landscape, with a foreground and background layer rising and lowering with the inhalation and exhalation. The images are uncomplicated and not distracting, but easily recognizable. There are also additional visual cues: a circle that represents time elapsed in a session and a line that represents breath “hold” time.

Sometimes I play an ambiance by itself, allowing my imagination to create my own imagery, or simply to use it as background sounds while I’m working or drifting off to sleep.

The settings give you a variety of options for customization.

You can chose between a male and female voice for inhalation/exhalation guidance: “Seth” or “Emma”. I’ve tried both and found that I’m more drawn to Emma’s voice, but I appreciate the ability to switch between the two. Also, it seems like there’s a slight change in voice inflection between some of the guidance cues, so even though the spoken words are the same, it doesn’t feel like you’re listening to a robot. That’s nice attention to detail!

This is the ultimate in making the app your own: you can stick with the pre-set breath exercises, or modify them to your liking.

Another lovely customization is the ability to adjust the breath lengths for each of the breathing exercises. While the established counts are research-supported, if, for example, the 7-count hold happens to be too long for you, you can adjust it. This means that you have the ability to completely personalize your breathing patterns, a valuable feature that I don’t usually find in apps like this. Of course, you can also choose the total length of each breathing session.

Finally, after each session, you have the opportunity to select a little emoticon that represents your mood, and there’s space to write your thoughts, should you want to jot down a few notes.

Because I feel that mindfulness, relaxation and breathwork should be accessible to all and not limited to those who are able to pay, I held off on the upgrade that I was given to me so that I could try out the free version first. My experience was not diminished at all, and that was really important to me.

Eventually, I did upgrade, which gave me access to the entire list of ambiances, which otherwise are locked. However, even in the free version, you can access some (or all — sorry, I upgraded before I found out!) additional ambiances by maintaining your practice streak, which is a lovely perk. Upgrading also enables you see all your past sessions and notes. But there is no subscription, which sets Unwind apart from other apps of its kind. There’s only a flat, one-time fee (at this writing, $5.99). I really appreciate that and would have happily paid it myself!

The bottom line is that I love this breathing app! Its obvious that the developer put a lot of thought into it, with a definite focus on the needs of the user. Unwind is the ideal complement to the other meditation apps that I use, and perfect for whatever breathwork I want to do. Because most of the features are accessible without the upgrade, I recommend trying this out to see if it works for you. If you do decide to upgrade, it’s a small investment for immediate access to all the ambiances and logged notes, and in my mind, well worth it.