February 2022 – Frantic Shanti

And Suddenly, Another Freakout

Last week, I had a Pap smear. If you’re not familiar with what that is, you must be either male or blissfully young. In brief, it’s a test for cervical cancer, customarily done every 3-5 years.

I knew my results would come this week, along with other lab results. I was in a work meeting today when I noticed my phone was vibrating. It was my doctor’s office…and I was too late to answer the call.

Me: It’s probably nothing.
Also me: OMG I NEED TO CALL NOW!

The doctor’s office didn’t leave a message.

And that’s when I officially tuned out the meeting. A flood of possibilities came rushing in. My boss needed to talk to me but I was trying to suppress the growing urge to call the doctor’s office immediately.

The urge won. I called and left a message and went back to work, but my head was elsewhere.

The fact that there had been no message was extremely unsettling, because it made sense that if there were really bad news, the office would want to speak with me directly instead of leaving a voicemail.

And my reaction shouldn’t come as a surprise, because having been hit with a cancer diagnosis before, I’ve become hypervigilant. Like it or not, my brain wants to prepare for the worst so that I don’t have that horrible fall from thinking that everything’s just peachy to slamming into a nightmare.

It doesn’t help that I’ve read sooo many stories of women talking about being completely blindsighted by frightening diagnoses, and all of them saying that they thought nothing of the missed call from the doctor since they knew they were perfectly healthy, blah blah blah.

Of course, I know better than this. And at least I was aware of the hypervigilance, aware of my body’s reactions and aware that I was blowing things out of proportion. But it’s that uncertainty that is so difficult to take. Even though I know my response, I know why it happens and I know that chances are everything is ok…I want that certainty.

As it turned out, the call had come from the nurse assistant to let me know that my blood work results had come in. This was a relief, although I admit I considered it a defeat that I couldn’t be mindful and breathe through it all.

Then again, as a cancer survivor, I need to cut myself some slack. Getting slammed with a devastating diagnosis once leads to understandable echoes, no matter what test results I’m waiting for.

For now, I’m calm. Of course, my actual Pap smear results aren’t in yet. Those should come tomorrow or the next day. The nurse assistant told me that they’ll probably be normal (OMG, how can anyone say that????) and they’ll be loaded onto the patient portal…unless they’re not normal. And then they won’t be.

Guess whose heart will be fluttering for the next few days?

Not mine, because I’ve got it together.

Kind of…

~~~~~~~~~~~~~~~~~~~~~~~

To be fair, I didn’t totally freak out over this. But scanxiety over test results is getting a little old, honestly…

Five Years Down and Moving Along

I had another oncologist appointment last week. This one was a milestone, since it officially marks five years since my breast cancer diagnosis.

Five years ago, I was told that with triple-positive breast cancer I had an 85% chance of survival…but there in the fine print was added “five-year survival”.

Delays in routine care due to the pandemic have resulted in more late-stage diagnoses.

With advances in treatment for HER2-receptor-positive tumors (HER2 being the third marker in “triple-positive”), that percentage has improving. But it’s still interesting to note that there’s a finite end to what reliable survival info your doctor can give you, since it’s hard to run longitudinal studies with a large group of participants.

In any case, my oncologist was happy to see me alive and kicking. With the pandemic, women voluntarily and/or involuntarily delayed preventative care, and as a result, there has been an increase in the percentage of women presenting with advanced-stage breast cancer (from UC San Diego Health). Given how far treatment itself has come, this is a distressing statistic because it means that we have effective treatments but patients are not getting them soon enough. So perhaps, for him, I was a five-year treatment success in the midst of all of this.

My oncologist’s concern now is less that my tumor will recur and more that whatever conditions were responsible for the first tumor might result in a brand new one. He still checked me over carefully. My bloodwork looked good with only a lower white blood cell count (“that may never recover,” he’s said in the past). I have no headaches, my bone pain has significantly decreased and other long term physical side effects from endocrine therapy have just about Sudisappeared.

Five years post-diagnosis I’m turning down another path, one that I would have never explored had it not been for what cancer made me face.

I’m still dealing with things like distractability issues, but that could also be due to menopause and the pandemic situation and maybe just the march of age in general. I’ve noted before that it’s hard to pull apart all the factors to identify a single culprit.

My oncologoist remarked that I looked like I was doing well, that I exuded a positive “aura”, and while I’m sure he didn’t mean that metaphysically, the truth is, I feel like I’m finally moving forward in my life again. This coming weekend I start a three-month yoga teacher training course that will move me down a new path for the future.

I still plan to keep posting weekly during this time. We’ll see how it goes!

What If It Isn’t?

“Supposing a tree fell down, Pooh, when we were underneath it?”
“Supposing it didn’t,” said Pooh after careful thought.
Piglet was comforted by this.
A. A. Milne

So, I felt a “lump” under my left nipple, what I refer to as my cancer-side. It wasn’t the same kind of lump that I remember from cancer but when I thought of how I’d describe it (mass, thickening, etc.) I came up with cancer-sounding descriptive words.

This “lump” was also way bigger than my tumor had been.

I think I feel “something” and –BAM!– my mind takes me to worst-case-scenario land.

Now you might think that I would reason with myself. I’d had an MRI in the late summer that showed nothing. A real lump that big would have shown up.

Again, it wasn’t a lump, it was a “lump”. But in the back of my mind, a film starting playing…

I was writing letters to my friends on how much I had appreciated their friendship. Practicing how to tell my kids that I wouldn’t be around to see them graduate from college. Posting my final thoughts here.

It sounds sooo melodramatic but my brain is like a motor boat left unattended with the engine running. And it’s just heading away on its own on a course that no one plotted.

Why do I “go there”?

There is a part of the brain called the Default Mode Network (DMN), which is the area that is more active when you’re at rest and otherwise not focusing on anything. There is a nice “plain-English” explanation here (from an accompanying article to meditation teacher Jon Kabat-Zinn’s Mindfulness course on Masterclass.com). It describes the role of the DMN in “self-reflection…social evaluations…memories…envisioning the future”. And it also notes that problems within the DMN can predipose people to a variety of cognitive issues, including anxiety.

Start my motor, cut me loose…and off I go.

This would explain a lot about my personal default mode.

The article goes on to describe how meditation can “keep the mind from wandering into stressful territory, like reliving traumatic events from the past or anxieties about the future.”

Well, it’s good that I’m meditating, then. But I’ve already put a lot of practice into panicking. I’m an expert hand-wringer. I have a lifetime of experience helped along by a series of anxiety-provoking events. Meditation is chipping away at my hypervigilance, but it’s a slow process.

The main thing that has changed, however, is that now I’m more aware when the motorboat putters away. It used to blindsight me and before I knew it, I was hit by a tidal wave of anxious sensations (tightening, gripping, nausea…). I didn’t realize that this habit of automatic thoughts was driving my anxiety.

Now, when I start down the road of “what if it is…”, I can stop and ask, “what if it isn’t”?

And that comforts me.

When I Can’t Keep Images Out of My Head

When I first started my mindfulness meditation journey, I was taught to use the breath as the point of focus. It is a reliable anchor, always there to return to when you inevitably drift off into thought. It is a stable grounding force that keeps us present.

But there are times when it’s hard to focus on the breath. Perhaps when the mind is especially busy. At those times, I switch to other bodily sensations, such as tingling in my hands or pressure from contact with the surface that I’m sitting on. I wrote a post about moving between two points of focus to help the mind maintain concentration without wandering off. That helps too.

Some days my monkey mind is particularly loud and attention-seeking.

And sometimes my chattering “monkey mind” calls for a switch to an auditory focal point such as gentle music, singing bowls, nature sounds or even simply street noises. Those will keep me present as long as I don’t fall into the trap of making stories about the sounds.

But some days are extra tough.

I tend to avoid meditating with my eyes open. Doing so only reminds me that I need to clean my desk or vacuum the carpet (“guilt-guilt, blame-blame”). However, I am a very visual person with a vivid imagination, and opening my eyes immediately grounds me if my thoughts get too pervasive when my eyes are closed.

Sometimes a thought will trigger an uncomfortable and anxiety-provoking feeling simply because a seemingly-innocuous scene has been associated with a disturbing event. The scene flashes before my eyes andbefore I know it I’m down a rabbit hole. Monkey mind is activated.

While staying with bodily sensations would be preferable, some days there are too many opportunities for my monkey mind to run away with me. It can get exhausting and counterproductive to “dodge” these visuals. Yes, we are “supposed to” let the thoughts pass by us without getting caught up in them. But there are days when they agitate me too much and throw me off track.

So I’m cutting myself some slack and turning the “problem” into the solution. On those difficult days, I focus on an image of my own choosing. Something that I can visualize clearly so that it keeps the monkey occupied while at the same time keeping me away from troubling scenes. You could argue that I’m “avoiding” the thoughts. But I see this differently–I’m giving myself a little break from them.

What works best for me? An image unencumbered by potent associations–this is different for each person. A tree, for example, works for me. It might be a thin white birch tree or as majestic and meaningful as Yggdrasil. The tree itself doesn’t matter as much as that I choose it according to what suits me and what soothes me. I can focus on its rough bark, veiny leaves and thick canopy and the sensations that these things evoke to keep away from creating stories.

And if this results in greater concentration, I have the option of hopping back to the breath. Or not.

This might not seem like an earth-shattering revelation. There are relatively popular mountain and lake meditations, so this concept is not new. But with all the emphasis on feeling into your breath in an effort to calm the thinking mind, sometimes it’s simpler to not worry about the “shoulds” and instead see what your own self needs to help it let go and settle into peace.