franticshanti

It’s Time to Ease Off Ourselves

You’ve probably heard this phrase in a commercial somewhere: “If I can do it, so can you!” It’s meant to make difficult goals seem attainable.

Some people may find this very motivating. And it certainly can be. Sometimes all we need is a little spark of hope to push us into achieving great things.

But it can also be used as an instrument to shame people into thinking that they’re not trying hard enough. That there’s something wrong with them.

Just because you’re not getting the results that someone else did does not mean that you lack a good work ethic.

From a marketing standpoint, the idea is that you push responsibility off the item or program or whatever it is you’re selling, and onto the person buying into it. Because obviously, there’s “proof” that it works. I mean, it worked for someone. So if you’re not getting the same results, it’s an issue that you have.

I’ve also seen this used with cancer patients. An exceptional individual who has defied the odds and still accomplished so much under negative circumstances is held up as an example of what is possible. They’re called an inspiration.

And it’s true, what they did was possible. For them. But we know very little about what else was going on in their lives to support their endeavors.

It’s admirable that these people are able to achieve what they have, but it’s unreasonable to expect that from everyone. And sometimes obstacles that no one else can see (emotional pain, underlying fears, mental illnesses) may hinder us, and the best that we can do is get through the day. Or sometimes, just manage to crawl out of bed.

We may know this and yet still hold ourselves to those standards, and as a result, reap disappointment.

Why am I bringing this up now?

Maybe it wasn’t that you didn’t try hard enough. Maybe it’s because the goal was not the right goal for you.

Because as a cancer survivor, I’ve expected things of myself that I simply cannot do anymore and then became frustrated with my inability to fulfill my unrealistic expectations.

And hated myself for it.

So this is a little reminder to consider what is right for you. Definitely, set goals and seek higher heights! But make sure they are your goals and they fit your life and abilities. That they are meaningful for you. This may require you to adjust your expectations in a way that demonstrates respect for yourself.

Because if someone is trying to amaze you with whatever they’ve done that they’re trying to convince you to do, consider that they might be getting far more out of your willingness to try to live up to their standards than you’ll get out if it yourself.

Mindfulness 101: You Want Me To Do WHAT in the Middle of Anxiety?

Ah, anxiety. I hate it but it’s such a fixture in my life, although it’s gotten better now that I’ve become more aware of the nuances of my reactions to stress.

That awareness was key, but it took a while for me to figure it out. I had been told to “feel what the response to anxiety feels like in my body”, but lemme tell ya, when you’re in the middle of being really stressed out, the only answer you can give is: “TERRIBLE!”

I think the way this suggestion has been posed is all wrong. It wasn’t until I started mindfulness meditation that I finally understood what was really the point of feeling into body sensations.

First of all, in case you’ve been fortunate enough to never experience severe anxiety, here’s how to imagine it: (1) turn on a really large blender, (2) stick your head in it. That’s about it. Then, when someone asks you to feel what body sensations you have, you answer, “Dunno, my brain is missing.”

If serenity is a clear day, this is anxiety.

Basically, in the midst of anxiety, there is so much that feels out of control that I don’t think it’s possible to lasso down sensations without having a person hold your hands, look into your eyes and say, “Okay, focus on me and do this…”

And that, my friends, is why scratching out even the slightest bit of space for yourself in a stressful situation, just so that you are not 100% caught up in the whirlwind, is so beneficial for getting yourself through it.

Just like you don’t wait until the day of your first marathon to start training for it, you need to prepare for the next tornadic episode of anxiety before you’re in it.

Become your own Professional Stress Manager. That takes practice, primarily when things are peaceful. Just like you don’t wait until the day of your first marathon to start training for it, you need to prepare for the next tornadic episode of anxiety before you’re in it.

Job One is bringing yourself out of the swirling thoughts in your head and that can be hard to do, since they are where your anxiety originates. That’s why you have to re-direct your attention to something outside your mind, and that’s where focusing on body sensations comes into play.

First, find yourself an anchor, like the oft-mentioned breath, and start with that. Focusing on the breath gives you a target for your attention when everything else feels crazy. There are a variety of sensations associated with breathing: the rush of air, expansion of the chest, expansion of the belly and whatever else is salient to you.

Pick one that makes sense. It is expected that you won’t be able to maintain your focus on it and your mind will wander off. That’s OK. In fact, the whole point of this is that you DO lose your focus. And once you realize that you have, bring your attention back to your breath.

And that’s it. That’s ALL of it. It doesn’t get more complicated than that.

And when you’ve achieved some sort of stability there, you’ve made yourself some space. Take advantage of that and bring your attention to other parts of your body, with one eye on your breath: is there a tingle in your fingertips? How about your toes? Are you clenching any muscles in your body and what happens if you try to release them?

Ask yourself, “How do I know I’m anxious?” What are the signs? Face feeling hot? Stomach bunched up? Cold feeling in the intestines? Tightness in the chest? Can I take a deeper breath and try to relieve that tightness? Can I send warmth into my gut? Try to define what anxiety means to you on a physical level. The more you do that, the more control you get on your reaction and the experience is not as frightening.

See, the idea is that you need that fingerhold in the crack between your stressor and your reaction to it so that you don’t get swept up in the lack of control. And establishing that will take some practice and time, but as with any exercise, each practice session will benefit you. And then best time to start is now.

Maybe Being Stinky Is Not So Bad?

From what I can tell, the loss of body odor following cancer chemotherapy isn’t widely acknowledged within the medical community, but it’s certainly something that many of us have experienced.

This is NOT what you think of when someone says, “sweaty armpit”!

Based on what I’ve read, this might be a result of the weedwhacking effect that chemo drugs have on our microbiomes. Regardless, the result has been positive for those of us who find that we don’t have to worry about being smelly.

However, I happened to catch an interview on National Public Radio (aka NPR) that helped make more sense of what was actually going on, even though it was a bit of a killjoy. Listen to it here, where you can also find a full write-up of the piece.

Basically, that sweaty stink that we find repugnant is from a compound produced by bacteria living on the skin. One species of these bacteria that’s associated with an onion-like odor is Staphylococcus hominis.

Our stinky sweat may offer some protection from stuff like MRSA, shown on this CDC photo. They might look like cute fuzzy purple balls, but in the age of antibiotic-resistant bacteria, they’re potential killers.

And unfortunately, these smelly microbes are very beneficial, helping protect humans from things like eczema and MRSA (antibiotic-resistant Staphylococcus aureus). As one of the researchers puts it, sweat is an “antibiotic juice” that forms a protective layer on our skin as it dries.

Yeah, I know what you’re thinking: cancer is miserable enough, and you HAD to take away this one little thing (loss of body odor) that was the only perk to chemo?

Well, as mentioned above, I’m not qualified to definitively say that it’s the chemo that kills the skin microbes and makes you not smell. I’ve been unable to find research studies that examine the effects of chemotherapy on your skin’s microscopic residents. Nonetheless, I’ve tried to contact the researchers mentioned in the NPR story to see if they’ve had any experience with chemotherapy and loss of body odor in cancer patients. If they reply, I’ll report back to you.

For now, if you’re happy being odorless, keep enjoying it.

Weighing on My Mind: Not the Scale Again!

Anyone who’s been through cancer knows that the experience is not just about the cancer. The entire journey involves much more, revealing even the little anxieties that had been tucked away in dark corners.

One of those for me was that I was constantly put on scales. EVERY single doctor’s visit, I was weighed. And I hated it.

It’s worth mentioning that I don’t have what most people refer to as a “weight problem”. Unless, that is, you mean being exceptionally diligent that I not put on weight. For me, weight was tied to self-worth, and in my perfectionist view, I was driven by fear of shame to keep my weight down.

At every single (frequent!) oncologist visit: “Step on the scale and I’ll get your weight.”

Ironically, the positive side effect of this was that I became very interested in exercise and healthy eating, and that has served me well. But of course, it took a long while for all of this to shake out into a truly healthy mentality, and particularly in my teens and early 20s, my mindset was not the healthiest.

By my 50s, however, I had a great relationship with my active, healthy lifestyle.

And then I got cancer.

And all of a sudden, hospital scales were all over the place, and even not being overweight, I sweated the weigh-ins. I sweated them when I first went to see my doc about the lump, when my weight started plummeting even before my first chemo infusion (hello, uncontrolled anxiety) and when post-infusion I was retaining water and my weight crept up.

I could write an entire post (or several!) about how, while I religiously weighed myself twice a week at home, I had intentionally put off several doctor’s visits over the years NOT because I was 10-20 pounds over a reasonably healthy weight…but because I was about three pounds higher than I felt I should be. Those three or four pounds would have disappeared on my 5’11” athletic frame, but that was beside the point.

There was an “acceptable” number and I wanted to make sure I was there before heading to the doctor.

The number of cancer visit weigh-ins was staggering. Every.single.time I saw the doctor (which was a lot), I had to hop on the scale. I would purposefully not drink very much water or eat less beforehand. It DID NOT EVEN MATTER that we were dealing with a life threatening illness. I absolutely hated getting weighed in a doctor’s office and I hated what the scale meant to me – that I was somehow never good enough.

Since adopting a spirit of mindfulness, my perfectionism has softened and I no longer abhore the weigh-ins like I used to.

I had internalized that belief.

Gradually, the number of weigh-ins decreased. It was as if a pot that was at full boil slowly simmered down. My mindfulness practice showed me not only that anxiety was not a helpful reaction to a stressful situation, but that the slight weight fluctuations that I obsessed about weren’t apparent to anyone else. Nonetheless, I had taken them to be indicative of yet another way that I felt I had fallen short of the person I “should have” been.

And that helped me understand and begin to deal with those unreasonable and even meaningless expectations I had of myself that were still lurking in the shadows.

So now, when it’s time to go to the doctor, do I fret the scale?

Well, I still feel that twinge because it’s a deeply-ingrained habit, but now I understand where that twinge comes from. And once I get off the scale, I forget about it and go on with my day.

Calming the Mind by Counting to 10 – with a Focus Twist

I’ve posted several times about different counting techniques that I’ve used to help calm and ground myself (counting backwards, counting 100 breaths). It sounds like such a simple thing, but it is surprisingly effective.

Counting is one of those things that we naturally learn when we are very young, and because it’s so familiar to us, we can do it with ease as adults.

Job #1 is to stop the swirling thoughts so that you can drop back to sleep.

This ease comes in handy when our Monkey Mind is jumping around like mad, stewing over what has happened or fearing for what is to come. Counting gives it something to do so that its attention is drawn away from anxious thoughts.

In particular, I’ve found this to be useful at night when falling back to sleep has been hindered by that incessant buzz of thinking that won’t go away.

The technique that I’ve used over the last few weeks weaves a counting pattern like this:

Become aware of your body lying in bed. Try to soften the most obvious places of tension (for me, neck and shoulders) and turn your attention to your breath.

Begin by focusing on your inhales of your breaths and counting them, up to ten. Then, switch your focus to your exhales, counting each one up to ten. And again, switch back to focusing on the inhales, continuing this way

The combination of counting up to ten and focusing on either the inhales or exhales provides enough of a distraction from your thoughts, but requires some gentle attention to keep on track. The switching of focus invites your mind to return to the breath.

Counting sheep might work just fine, but counting breaths helps you stay present and grounded.

I’ve found ten to be a very good number; however, five would also work. Whatever you prefer. This might require experimentation to see what is best for you. For example, counting to two might work better for some people during waking hours when there is naturally more stimulation around.

As you establish a pattern with your breath, extend your exhales regardless of where your focus is. This helps slow both your breath and heartrate.

Again, this technique works because counting to ten is simple and unstimulating, allowing the mind to lull itself into a calmer state. When I find myself missing ten and instead counting into the teens without switching my inhale-exhale focus, I know that I’m beginning to drift off. I gently stay with it, but sleep is nearby.

Another Oncology Appointment…and What’s Up With That Smell?

My oncologist appointment last week marked five years since completing my final chemo infusion (and for those of you keeping track, since I had that nasty chemo nail infection).

Lately, my oncological appointments run like this: my onc asks how things are going, I air all my grievances and we spend the rest of the visit agreeing that there’s no way to determine whether what I’m experiencing is chemo-related, menopause-related, or something that I was dealing with before but hadn’t paid attention to back before cancer.

Because there’s nothing like cancer to make you acutely aware of every twinge and creak in your body.

But that’s about it. We are running out of things to talk about. In this context that’s a good thing.

I used to lament “what could have been” had I not gotten cancer, not experienced chemo, not been pushed into menopause chemically and artificially had my estrogen levels squashed. But now, I know better. What happened, happened. And “what could have been” is pointless to ponder because it simply isn’t reality.

It took me a while to get to that place and I’m finally okay with it .

But there was something else different about this oncology visit…

I walked into the cancer center for my appointment and was hit with “the smell”. There is a distinct scent in the building, possibly the cleaning solutions used to disinfect the place or maybe a fragrance that is purposefully pumped in. I had mentioned it to my clinical counselor several years ago and she admitted that a number of people have said the same thing. The smell is familiar, given that after multiple appointments and infusions and radiation sessions, I’ve experienced it a lot and have made many associations with it.

But for some reason, this time it hit me hard and a wave of sensations washed over me. Not sure why my reaction was so strong, but I’d like to think that between my last onc appointment and this one, I’ve made the most progress in distancing myself from the frustrations of getting cancer and have actually moved on with my life.

However, that rush of emotions served as a reminder of everything that I’ve been through over these past five years. I thought that chemo was going to be the hard part. Turns out, it was the most predictable part: six trying infusions, but they came with an end date. The rest of treatment brought uncertainty and unexpected difficulties. I thought I was done after radiation…but the pills continued.

Looking back at this, while I’m technically not “out of the woods” and may never be, these last six months have felt different. Yes, I still have another onc appointment half a year from now, but I’m finally turning my face forward to the future instead of constantly looking back at the past, worried that those frights will catch me again.

Exercise Trumps Genes for Longevity

By now I’m probably sounding like a broken record about how important exercise is to all aspects of your life, but here I go again…

Although this is not specifically about cancer, an article recently published in the Journal of Aging and Physical Activity (Posis et al., 2022) scored another point for the benefits of maintaining an active lifestyle.

This study was conducted at the Herbert Wertheim School of Public Health and Human Longevity Science (University of California, San Diego), where the researchers examined the effect of physical activity/sedentary time on longevity in women. The 5400+ study participants spanned the entire range of genetic predispositions for longer or shorter lives. You can read a synopsis of the research here.

The results of this prospective study (2012-2020), while not surprising in the grand scheme of things, can be considered a wake-up call.

Regardless of their genetic predisposition, women who engaged in higher levels of activity had a lower mortality risk and those who were more sedentary had a higher risk. This is important, because it’s tempting to think that if your family members are long-lived, you will be too. However, your own activity levels do matter.

In addition, being physically active was effective in extending the lifespans even of those women whose genetics suggested a shorter life.

This can be considered promising news: you do have some control over your lifespan. Even when you’ve been dealt what may seem like a losing hand in terms of longevity or disease, providing your body with the supportive behaviors that it needs and deserves still makes things better.

It’s easy to forget this when we focus on the negatives in life. And while we do need to acknowledge our hardships and allow ourselves time to grieve for our losses, making choices that benefit our bodies and minds is a sign of respect for ourselves.

So go ahead, soak those tootsies…then get back outside for a walk. And don’t stop.

Unlike a glass of wine or a rich dessert, commonly considered an “indulgence”, self-care in the form of moving ourselves, step by step, day by day, closer to a healthier lifestyle is the kindest, most loving indulgent act you can ever do for yourself.

What one little thing can you do today that you didn’t offer to yourself yesterday that will move the needle further towards a more active life?

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References:

“Physical Activity May Have a Stronger Role than Genes in Longevity” by Yadira Galindo, UC San Diego News Center, August 24, 2022, https://ucsdnews.ucsd.edu/pressrelease/physical-activity-may-have-a-stronger-role-than-genes-in-longevity.

Posis et al., (2022) Associations of Accelerometer-Measured Physical Activity and Sedentary Time With All-Cause Mortality by Genetic Predisposition for Longevity, J Aging Phys Act, https://doi.org/10.1123/japa.2022-0067.

What Would You Like to Think About? – Visualizing a Positive Headspace

Some time back, I listened to a lovely guided meditation on the Insight Timer app by Emma Polette in which she instructed the listener to “feel how you want to feel”. I wrote a post about this because I thought it was a perfect morning exercise, one that helps train you to establish a sense of awareness of how much control you yourself have in how you feel.

Well, I wanted to revisit this concept but with a focus on thoughts, since so many of us deal with overactive minds.

Take a comfortable seat and think…what would you like to fill your head up with?

Find yourself a quiet spot and turn your attention to your thoughts. Regardless of how much brain chatter you’re currently experiencing, consider what you would like to be thinking about.

That’s it. Your mind may be cluttered with worries, but IF you could think about something pleasant and calming, IF that’s where your mind’s focus could be, what you be thinking about?

Allow yourself to sink into this. Maybe your mind would be focused on potential successes in your career, troubleshooting a problem that you haven’t had time to devote attention to? Maybe you would simply focus on the task at hand, without intrusive thoughts invading your headspace? Maybe you would sit quietly without feelings of self-blame or incompetence? Or imagine yourself breezing through a situation with a difficult individual?

Ah, headspace! There’s nothing more delicious than getting a nice big helping of perspective.

The act of asking ourselves what we would like to be thinking about requires us to take a step back and make space for it. The realization that we have the ability to decide what to think about unshackles us from our thoughts. The more we do this, the more we widen the gap between what we think and our concept of ourselves, making it easier to observe the thoughts before us rather than to be sucked into the torrent of images and feelings that course through our minds.

What we fill our minds with is so powerful in terms of affecting certain wanted outcomes. It is often during periods of mindfulness meditation that things I’ve forgotten come back to me, I realize solutions to problems or come up with useful ideas. That’s what a calm mind is perfect for.

And so often, people lament that things are not they way they want them to be. So why not use that opportunity to truly feel into and savor what your mindset would be if things felt good? And then, if it’s available to you, maintain that mindset.

What would you be thinking…and how would that feel? A sense of peace and self-confidence? Perhaps space, distance from negative thoughts.

Give it a try and see how it feels.

Extending Life with Immunotherapy: Advances in Treating Triple-Negative Breast Cancer

The August 9, 2022 edition of the National Cancer Institute’s Cancer Currents blog announced the findings of the clinical trial KEYNOTE-355 that examined the benefits of using the immunotherapy drug pembrolizumab (Keytruda) in conjunction with chemotherapy in treating advanced triple-negative breast cancer (TNBC).

The results, published in the New England Journal of Medicine (Cortes et al., 2022), revealed that pembrolizumab in conjunction with chemotherapy was effective in extending the lives of TNBC patients with advanced disease as compared to chemotherapy alone, and the difference was striking. Those who received the drug lived a median of 23 months compared to 16.1 months for the chemo-only group.

Sources: Cancer.gov, Cancer Currents blog

Of course, cancer differs among patients and not all TNBC tumors are the same. The life-prolonging benefits of pembrolizumab were limited to those patients with PD-L1 scores of at least 10; PD-L1 is an immune checkpoint protein, and the score denotes the level of this protein found in cancer tumor cells.

And it’s important to note that while the drug extended life expectancy, it was not yet a cure, which is what we’re all still waiting for.

So there are asterisks associated with these findings, which might be disappointing for those with advanced cancers of this type. But the researchers stressed that this is a very promising outcome.

Consider the advances that have been made. TNBC used to be treated with untargeted therapies, kind of like throwing everything you’ve got at the tumor and hoping that something “sticks”. On the other hand, pembrolizumab is a targeted therapy for this specific subset of TNBC, and that makes a huge difference.

There has been a push to address the complexities of TNBC and large strides have been made in understanding what makes it tick. New therapies are being approved and they are making researches optimistic about eventually being able to cure the disease.

As an example, in April 2021, the FDA approved the use of sacituzumab govitecan (Trodelvy) for the treatment of certain types of TNBC (after conditional approval had been granted in April 2020). As noted in the May 12, 2021 edition of the Cancer Currents blog, sacituzumab is comprised of an “antibody coupled to a more potent form of the chemotherapy drug irinotecan (Camptosar). The antibody binds to breast cancer cells, delivering the chemotherapy directly to those cells.”

There’s good news for some patients with advanced triple-negative breast cancer.

Notably, patients receiving sacituzumab lived a median of 11.8 months longer compared to 6.9 months for those patients receiving the chemotherapy alone. Positive results were also obtained for patients with brain metastases, where the cancer has spread to the brain, who tend to have worse outcomes when treated only with chemotherapy.

There is still so much more to learn. Cancer is a puzzle and researchers have known for some time that the pieces do not yet fit together cleanly. But each one of these advances brings us more effective treatments for TNBC, addressing more specific targets on the tumors. Lifespans are increasing and for many, cancer is taking the form of a chronic disease, not a death sentence.

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REFERENCES

Cancer Currents Blogs

Sacituzumab Govitecan Approved for Metastatic Triple-Negative Breast Cancer, Cancer Currents, May 28, 2020: https://www.cancer.gov/news-events/cancer-currents-blog/2020/fda-sacituzumab-govitecan-triple-negative-breast-cancer

Sacituzumab Govitecan Earns Full Approval for Triple-Negative Breast Cancer, Cancer Currents, May 12, 2021: https://www.cancer.gov/news-events/cancer-currents-blog/2021/sacituzumab-govitecan-tnbc-regular-approval

Pembrolizumab Improves Survival in Advanced Triple-Negative Breast Cancer, Cancer Currents, August 9, 2022: https://www.cancer.gov/news-events/cancer-currents-blog/2022/pembrolizumab-triple-negative-breast-cancer-improves-survival

KEYNOTE-355 Clinical Trial
(as of this posting, the full article is not yet available to non-subscribers)

Cortes et al. (2022) Pembrolizumab plus Chemotherapy in Advanced Triple-Negative Breast Cancer. New Engl J Med, 387, 217-226. 10.1056/NEJMoa2202809

Presence by Touch: A Visualization

Staying present is key for not letting your thoughts take you on a wild ride.

Maintaining presence, however, takes practice so I’m always on the lookout for new ways to imagine the state of being in the “now”. Some of these are simpler exercises than others, but the upside of a more “complex” technique means that all my mental energy remains on staying present instead of, say, worrying whether I embarrassed myself at a party three nights ago.

The following is a visualization and mental exercise rolled into one:

What if only what you’re touching exists and everything else falls into nothingness?

Seated, close the eyes. Breathing deeply, allow everything that is around you to fall away in your mind, leaving only those points where your body makes contact with the surface beneath you.

Imagine that the soles of your feet sit on top of sole-shaped pieces of support material. Your buttocks and thighs contact like-shaped material, as does any place your back rests against your chair. If you touch your fingers to the side of your chair seat, small oval-shaped pieces of material appear where your fingers make contact.

Everything else disappears against a background of light (or darkness, if that is more calming). The chair and floor and even the room you are in? Gone. The point of this visualization is maintaining focus on only what you are physically experiencing at any given moment.

It is a strange sensation to imagine, floating through the ether but still feeling support from the slightest bits of material that touch you. This is the ultimate in being 100% present and turns the concept of object permanence on its head.

You don’t feel it? It doesn’t exist.

Our brain wants to fill in the parts that we can’t see because the brain has formulated an image of what is out there. However, in this practice we try to do the opposite–let go of what we do not have immediate physical evidence for.

This is a good analogy for dealing with thoughts that our brain fabricates based on the expectations that it has. What if we let go of them, if only for a short while, and simply sit in the stillness of what is happening right now?