February 2021 – Frantic Shanti

After Four Years of Treatment, Calling It a Day; or, “If It’s Not One Thing, It’s Another”

I saw my oncologist last Thursday, February 18th.

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.

Yes, this should be me right now, since I’ve eagerly awaited this day for a long time. But it’s complicated…

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?

The Case for Chilling Out: Stress and Cancer Recurrence

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.

Findings in the lab may explain what’s going on in the human body–and ultimately lead to treatments that prevent cancer recurrence.

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.

Learning how to keep stress under control may be one of the most important things that cancer survivors can do to help prevent canver recurrence.

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.

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For a reader-friendly version of this study, go to the National Cancer Institute’s Cancer Currents Blog’s article, “Study Suggests a Link between Stress and Cancer Coming Back”.

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.

Mindfulness Apps I Love: “ZenView”

ZenView is 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.

This is the default “theme” that comes up. It’s been my favorite for a number of years. The menu is accessed via the cross at the bottom right.

The menu is intuitive and easy to navigate. Here, you can select from a number of themes on the left.

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.

Here, raindrops fall on the bamboo theme. The photo doesn’t do it justice, as it does appear as if you’re looking into a puddle as the rain comes down. The movement of the ripples is soothing and calming.

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.

Mental Grounding Through the Roof of Your Mouth

Okay, this is going to sound weird, but I’ve found that this really works.

A little background: in the midst of a stressful situation, I struggle with staying present and grounded. While I try to focus on and slow my breathing, that can be ineffective, since my heart is often beating quickly and, you guessed it, focusing on my breath brings me to close to my heart. It’s hard to ignore the pounding.

I’ve written before about turning attention to the extremities, in particular the hands and feet, feeling into the sensations there, since they are as far as you can get from your heart and still be in your body.

But most of us are very aware of our hands and even our feet since we get signals from them all day long as we manipulate objects and walk around. It’s not a new sensation. Even digging your nails into the palm of your hands may end up as a stressor of its own (ow!).

Granted, we’re not hippos. But IF we were, we would have a whole lotta palate to explore!

However, one place in our body that can still elicit novel sensations is the roof of the mouth. Even for someone like me, who often scratches my palate with hard veggie stems and uses my tongue to feel around up there, the ridges and other surfaces still seem new and unexplored.

Imagine that you’re drawing a topographical map of the inside of the mouth: feel where the teeth sit in the gums, and the hard area to the inside of the teeth traveling deeper in, how that hard ridge drops off into the concave part of the hard palate, curving up and then softening into the soft palate.

One of the supposed benefits of stroking the roof of the mouth with the tongue is that doing so can purportedly stimulate the vagus nerve, and thereby the parasympathetic nervous system, because the vagus nerve rests close to the surface of the inside of the mouth. All of this may have a calming effect, which is exactly what you’re looking for.

Just thinking about the sourness of biting into a lemon makes my salivary glands go bonkers!

It’s also worth noting that in the throes of stressful situations, our mouths tend to dry out. Something to try the next time you’re anxious and cotton-mouthed: elicit salivation by simply thinking about something extremely sour–imagine biting into a slice of lemon. Try that now, visualize it as realistically as you can, and chances are your salivary glands will respond. Mine are just writing about this!

When you are able to focus on bodily sensations you bring yourself back to the reality of the here and now. It removes you from the fear of what may be, and gives you the opportunity to come back to Earth, take a deep breath and carry on.

So next time you are feeling overwhelmed, see if you can allow the novelty of the roof of your mouth to buy you some breathing room.