My recent post, Just Show Up, about releasing the need to fight through breast cancer treatment, left out an important concept.
My cancer diagnosis was what I deemed the “worst-case scenario” from the viewpoint of everything that came before. The overwhelm was a tidal wave that caught me and spun me around. Disoriented, I struggled to breathe and find my footing, but it was too much and I was poorly equipped to deal with the news.
I went through the motions, stumbling through the appointments that now multiplied in number. There was so much information to wade through, decisions to make, upcoming treatments to fear.
Then a co-worker whose wife had been diagnosed with cancer some years before sat down with me and gently offered a valuable piece of advice.
I didn’t have to handle everything at once. Some the decisions could be made later. Each day would bring answers and more clarity. There was no need to load up on all the information. It didn’t help anyone get through these days, all it did was weigh them down.
The path through this entailed focusing on what needed to be done now, and then working on doing that and only that. Just taking that one easy step forward.
All that stuff in the past and the things to come, you can release them. Don’t carry that extra burden with you. Just focus on what’s happening now. And now.
I mentioned a few posts back that in addition to stopping letrozole (an aromatase inhibitor) which had originally been prescribed to me as long-term endocrine therapy for breast cancer, I saw a cardiologist. I was experiencing what felt like irregular heartbeats. Since arrhythmias have been associated with aromatase inhibitor use, I wanted to make sure that I wasn’t going from one problem to another.
The cardiologist I met with ran an EKG, listened to my heart and told me he really didn’t think I had any issues. However, he ordered an echocardiogram and a Holter monitor just to be on the safe side. I did both tests.
A week ago, I met with him to go over my results. He was pleasant as always, asked me how I was feeling–I was feeling great, actually, since I was pretty positive that I’d imagined any heart issues because I’d experienced little since I turned in the Holter monitor for analysis. So, if anything, I was a tad embarrassed for blowing things out of proportion. Geez, I’m such a hypochondriac!
That’s good, he said, equally pleasantly. “Because we found something.” Equally pleasantly.
I had not expected that. What I was expecting was, “everything looks normal.”
However, looks like there were some arrhythmias: supraventricular tachycardia and supraventricular ectopics.
My doc wasn’t concerned. He said that based on other data (72% left ventricular ejection fraction [LVEF]) my heart was healthy and strong.
Ooookay. But I was a little shaky that my concern about extra beats had been confirmed. Because I hate fearing that something’s wrong and finding out that I was right in fearing it! I’d prefer that it be all in my head.
Then we delved further into the echocardiogram. I shifted uncomfortably in my seat.
On the plus side, lots of things were normal. That’s good.
However, way back in early 2018, while I was receiving infusions of Herceptin, my then-cardiogram showed pericardial effusion (fluid where it shouldn’t be), but in a subsequent echo it had “fixed” itself. Well, that was back now. Also trace mitral and tricuspid regurgitation: my valves are a touch leaky. My cardiologist wasn’t too concerned about it. “Wear and tear,” he said.
But he also noted that I had a marginally “dilated proximal ascending aorta.” Right after which he noted that I was tall, suggesting that there could be error in the extremes. But neither one of us was 100% sure whether that was a change from the previous echo, based on how the report was written. And he questioned some of the values, saying that echocardiograms weren’t perfect or always accurate.
At the same time, he wanted me to come back in a year for another echo. Just so that we can be sure that the dilation hadn’t progressed. “Then we worry,” he said.
I left the office with questions swirling inside my noggin and decided to do some computer research, which I immediately regretted.
First of all, “dilated proximal ascending aorta”, when googled, brings up a gazillion results about aneurysms.
I know I don’t have an aortic aneurysm. But I have to wait a year to see if the dilation progresses. That’s 365 nights of staring at the ceiling. And I have to make sure to remain calm and not harrass myself into elevated blood pressure, because that can put more stress on the blood vessel and dilate it even more.
Oh, and the supraventricular tachycardia and ectopics? Those are improved by exercise (um, yep, been doing that) AND by staying calm.
Try yoga and meditation, the websites suggest.
Okay, yep, been doing that too.
So where am I with all of this now? Obviously, I need to keep doing what I’ve been doing. But this really does underscore a couple of things:
1) Meditation and mindfulness are critical to our well-being. These are habits to establish now (yesterday!) and not stop. Ever. 2) Cancer casts a long shadow. You might be fortunate enough to earn the title of “cancer survivor”, but that doesn’t mean that it’s all giggles and rainbows afterwards. Cancer treatments are tough and while we’re furiously obsessed with doing whatever we can to minimize the chances of cancer returning (because that’s Job One), someone at some point needs to start thinking about what happens once the cancer is gone and we have to clean up after the long-term effects of the treatments.
Could my heart “issues” (I don’t know if they are serious issues yet) have been caused by Herceptin infusions, radiation to the chest and aromatase inhibitors? Yes, they could have. But could the fact that I am highly reactive and have a strong response to stressors played a role in this? Yes, of course.
And does it really matter? No, in all honesty it makes no difference. Whatever happened has passed. My only path through this is a calm heart and solid grounding on the Earth. I’ll know more about my physiological state in a year, which gives me another twelve months of daily meditation and exercise, and an even better appreciation of how my mind generates agony.
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.