Is It Metastasis or Menopause?

Ever get the funny feeling that something’s wrong?

Like things are a bit “off” but you can’t be sure? I’ve been dealing with that ever since I got off letrozole, an endocrine therapy for breast cancer with a reputation for being difficult to take.

As of this posting, I’ve been off letrozole for 117 days exactly–yes, I’m counting. I’m still shaking off side effects like stupid-crazy joint stiffness, but at least I can tell things have improved.

That’s not what I’m talking about here.

I’ve taken a few rides in the MRI tube already. Not in any hurry to repeat that.

Right now I’m having some “really intense” memory and focus issues. I’ve put “really intense” in quotes, because I talk in superlatives so that my concerns are taken seriously. It’s a bad habit, especially when speaking to an oncologist, because it’s a sure way to end up in an MRI tube. Again.

In the past, my oncologist suggested that my memory problems might have been related to anxiety and not the medications I was on. That’s quite possible, although it’s hard to tease apart “anxiety” and “med side effects”. I mean, simply being told you have cancer causes an immediate spike of the Stress-O-Meter. For someone as anxiety-prone as me, it’s like I’m constantly red-lining.

Now I’m off the endocrine therapy and my memory and distractibility seem to have gotten even worse. What I had before wasn’t like THIS.

It’s kind of like saying, “This hurts. I think I’m being hit on the head with a hammer.” But then you actually get hit by a hammer, and think, “WHOA, now THIS is being hit on the head with a hammer!”

If thoughts are beads on a string, my beads are dropping off at a constant rate, leaving me wondering what I was about to do three seconds ago. And getting distracted by shiny objects. Couple that with having to learn a complex new financial system for work (grrrrr, Larry Ellison), not having helpful documentation to do so and having to go through that while being mainly confined to my bedroom for over a year…yeah, it’s a mess.

I am not being rational and I know it. But I’m still on high alert and dialing my fears down is going to take time.

Because my breast cancer was HER2+–which has been associated with metastases to the brain–my anxious little self immediately thinks, “Wait, maybe this is cancer’s spread stealing my thoughts???” I think that I will forever be jumping to that as the first possibility.

That’s not completely unreasonable, either. According to “Medical News Today”, memory problems are listed as one of the symptoms of brain metastases, along with headaches, stroke, seizures, confusion, dizziness…okay not really experiencing any of those.

And the Mayo Clinic metastasis website asks: what are the most likely causes of my symptoms? So, I admit, a brain tumor probably isn’t, given all the other more likely possibilities: menopause, work stress, loneliness, lack of purpose…and *cough* listening to Twitch video streams while I’m trying to focus.

So really, these memory issues could be a completely normal effect of menopause, but in the cancer context the possibilities are frightening. It takes a lot of perspective to be able to look at what’s going on and realize that it’s not aberrant or dangerous. I feel like an idiot for jumping to the worst conclusions, but here I am…

It’s a survivor thing.

Mindful Games I Love: Meditating with “Playne”

I didn’t think I needed a video game to help me mediate.

In the description for “Playne” (on the Steam platform), the developer states that the game is designed to help you establish a meditation habit. While, I thought it would be uninteresting for someone who already had a solid habit, the reviews of the game were very positive and the concept seemed inviting, so I decided to give it a try.

After a week of meditation, saplings have emerged.

I had no idea that it would have such an impact on the quality of my meditation. While I often listen to ambiances (such as through the “MyNoise” app and website) and use guided meditations (“Calm”, “Insight Timer”) or similar auditory cues (“Unwind”), what I didn’t have was a visual representation of my meditation practice as it progresses over time. “Playne” supplies that.

“Playne” has three modes: Story, Sandbox and Evolve. This post is about the Story mode, as that’s the one most people start out with and the one I’m currently working on. Sandbox allows to you build your own meditation spaces and Evolve can only be unlocked after 100 days of meditation (I’m still in the 50s).

You have a small selection of meditations to choose from with the emphasis being on learning to sit with yourself.

The game starts out on a semi-barren island with only a tiny flame in a campfire, a stone lantern, several rocks and Sensei Fox to keep you company. There are both guided and unguided meditations to choose from and as you meditate everyday, the fire grows taller and seedlings sprout and grow. With consistency, you unlock different story chapters, which wise Fox relates, gain the ability to change the weather, and most importantly, grow the island into a beautiful meditation retreat. All it takes is patience.

There is a breath bubble to guide your breathing if you wish, and also a ring that serves as a countdown timer. Both can be turned off if they are distracting or unnecessary.

You are given the ability to chose the length and type of your meditation. In addition, you can regulate inhales and exhales (the length of which you can designate) with a breath bubble, keep track of your meditation time with a minute-ring, enable a journaling option (known as “thought pages”, which you can either keep or burn in the fire if preferred), and mark each instance that you become aware that your mind has wandered (as I enthusiastically wrote about here). There are different places on the island to meditate, and as you accumulate more days, you not only get more weather options to chose from, but also access to elements such as birds, fireflies, Aurora Borealis and butterflies. These are quite lovely and make your “Playne” even more inviting.

Be forewarned that there is the temptation to mark your progress and count achievements. I understand why, from the viewpoint of a game, this is necessary but it does go against the concept of mindfulness. On the other hand, I’m really looking forward to flowers and butterflies!

Now for the potential downside: As much as I enjoy all the offerings, there are a few parts of the game that seem antithetical to mindfulness meditation. The game keeps track of “effort”, you gain “achievements” and note your “progress”. As do other meditation apps/games, “Playne” maintains a record of your streak, and depending on your settings, if you don’t log in to meditate with “Playne” on a given day, you run the risk of having the flame in the campfire go out. While I know that this is done to encourage daily meditation, it is also somewhat problematic, as the whole idea of mindfulness is non-striving. I feel that too much emphasis on achievement in the context of a meditation practice goes against being mindful of the present.

Over 50 days into this, my Playne has grown significantly.

Being of a naturally competitive nature, I was reluctant to turn my practice into one where I would be clinging to achievements. Nonetheless, there are enough positives to this game, and it has benefited my practice so much, that I have been learning to let go. That in itself is a significant improvement!

Yes, it’s unlikely that I will risk breaking my streak, but that’s pressure I can live with.

Reservations aside, I am really impressed with the game. I will write about the Sandbox and Evolve modes when I get to them, and post more images as my “Playne” grows. Additionally, there is a virtual reality (VR) option that I am looking forward to playing with. For anyone starting out with meditation, “Playne” offers a solid platform from which to develop and maintain a consistent meditation habit.

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In addition to “Playne”, I am also using other mindfulness media on a regular basis (my favorite ones are here). That makes for a lot of checking in with electronics, unfortunately. I’ve gotten to the point where I meditate about a half-hour to an hour-plus every day. While it’s a priority in my life, there are days that it’s a struggle to find time for it all. Introducing “Playne” has added to this, and the last thing I need more of in my life is stress.

Sometimes I combine “Playne” with other apps to take advantage of the “Playne” ambiance while doing my favorite guided meditations. More recently, however, I’ve also used “Playne” as a way to emphasize unguided meditation, and that has allowed my meditation practice to mature and expand beyond the confines of a computer program and into the rest of my day. That is one of the greatest benefits of this program and the main reason why I have found it so valuable.

Endocrine Therapy: Getting to the Heart of the Matter

Looks like visiting a cardiologist after stopping aromatase inhibitors for breast cancer was a good idea after all.

The letrozole (aromatase inhibitor) that I’d been taking has been associated with cardiovascular effects, and since I was feeling progressively worse from the medication, I wanted to make sure that everything checked out okay.

With the improvement in surivorship comes an increase in the diseases that come about from cancer treatments. The longer people live, the more long-term effects take their toll.

It seems like the American Heart Association (AHA) agrees with my concerns. An April 26, 2021 statement by the AHA underscored the complicated picture of cancer treatments, in this case hormonal therapies for breast and prostate cancer. As stated in the article by Okwuosa et al. (2021) published in Circulation: Genomic and Precision Medicine, “As patients with hormone-dependent cancers continue to live longer, CVD [cardiovascular disease] has emerged as a leading cause of mortality and morbidity among survivors of these cancers.”

Ironically, breast and prostate cancers are some of the most common cancers in women and men, in addition to having some of the most effective treatments. The number is of breast and prostate cancer survivors is growing. Part of the success of treatment is expressly due to the development of hormonal therapies for long-term (5-10 year) use. At the same time, the increase in CVD problems is a result of this success, because as cancer survivors age they experience greater amounts of age-related cardiovascular events than do non-cancer surivors.

So, what do you do when the treatment that’s increasing your chances of beating cancer may also be increasing your chances of a cardiovascular event? Isn’t that one of the many problems with cancer? If your treatment works well, then that opens the door to having it work “too enthusiastically”, possibly with long-lasting negative effects.

It still comes down to healthy behaviors.

The AHA statement paper cited here stresses the importance of communicating with your oncological team about CVD risk factors and possibly requesting a referral to a cardiologist, having appropriate tests conducted (ECG/EKG, echocardiogram), and–in my opinion the most important thing the survivors themselves can do–modify lifestyle (diet, exercise, smoking cessation, etc.) to maximize your chances of a cardiovascular event-free survivorship.

While it may be frustrating to think of entering into an “out of the frying pan, into the fire” scenario with a potential leapfrog from cancer to CVD, nothing is written in stone. You can make an effort to protect yourself and avoid being a statistic. Focusing on healthy living will benefit you in many ways and is guaranteed to improve your life, no matter what your risks.

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Link to the AHA statement:
Okwuosa et al. (2021) Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association. Circ Genom Precis Med,
DOI: 10.1161/HCG.0000000000000082

Link to a reader-friendly version:
People Taking Hormonal Therapy for Breast Cancer Have Higher Risk of Heart Disease, Monitoring Recommended, https://www.breastcancer.org/research-news/higher-risk-of-heart-disease-for-diagnosed-people-taking-hormonal-therapy