I wanted to share a little technique that I’ve been using to give myself perspective. It’s quite simple: I have a small brown paper bag pinned to the wall above my desk.
The bag is there to remind me that most of the things that are upsetting me or stressing me or just taking up headspace in the moment are transient issues that fit into that paper bag. The REST of my world remains outside that bag and unbothered by whatever is going on in there.
The trick for me is to not get sucked into that brown bag. When that happens, and it does, I’m suddenly whirling around with all the daily stressors and emergencies-of-now, and that’s all I see. My entire experience becomes those anxiety-provoking elements and my stress levels skyrocket.
When stress levels are high, it’s easy to get sucked into a space of high anxiety where you see only those stressors, forgetting that the rest of the world is outside.
It takes a lot more effort to fight my way back out of there than to stay outside in the first place.
At the same time, it’s so easy to follow all those stressors right into that bag. For me, that’s the path of least resistance, even a habit.
But when I lean back and take in the entire picture–the time-limited nature of what’s bothering me and the fact that in a couple of weeks it’ll be gone–my view broadens and I am reminded of what else is going around me right now, in this moment.
Right here, where I feel my feet planted on the ground. I smell the scent of lemon wafting up from my diffuser. I’m aware of sounds from the street below and sunshine coming in through my window.
Perspective. All of these things tumbling around inside the bag will pass. And, yes, perhaps more importantly, new ones will bubble up and take their place. I can’t stop that and I have to accept it. But I can take a deep breath and stay in the bright light of the day instead of darkness of that little bag.
I am a newly minted registered yoga teacher (RYT-200), having passed my Yoga Teacher Trainer (YTT) final exam in mid-May 2022. When I tell people I’m a yoga teacher, they naturally assume that I am extremely flexible and have impeccable balance.
But, no.
Yes, yes, when I’m warmed up I can touch my toes with straight legs, even put my palms flat on the floor…but in yoga practice, I prefer to keep a slight bend in the knee in forward fold. My balance is a little wonkier and I’ve been known to wobble and trip my way around a corner if I’m moving quickly.
I enjoy a deep yogi squat because I’ve been practicing that pose since childhood, but neuropathy pain in my feet prevents me from holding my back heel up high in lunges. So my abilities are spotty.
The gift of yoga is that it is available to all.
When I took level 2 yoga classes, part of the prerequisite for my YTT, I would regularly lose my balance in some of the moves that the younger class participants easily nailed. It took more brain power and concentration to keep my body steady (possibly chemo brain played a part). I’m sure other students would have been surprised that I was in yoga teacher training.
I mean, WHY would I even consider becoming a yoga teacher?
Because I want people to know that yoga is for everyone. While I’ve ranted about this before here, going through YTT classes really underscored the fact that, at least in the United States, yoga practitioners tend to be very homogeneous: young, white, female, flexible, affluent.
Come as you are. Nothing special needed.
This is particularly disappointing because there are other populations that would benefit greatly from establishing a yoga practice and arguably might need it even more for their well-being. Slowly, yoga is being made available to “the rest of us”. But it’s going to take a while.
So I urge you, seek out yoga in parks and free classes at the Y. Explore YouTube for gentle beginner yoga videos so you can practice from home. You don’t need the burning sage, expensive yoga pants, organic cork blocks or trendiest mat. You just need to show up, follow along with the poses and breathe.
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To be fair, my balance and flexibility have improved significantly with regular yoga, and that’s my point: I didn’t need to be super flexible to begin. No one does. But if the message that yoga studios and fellow yogis are sending is that you already need to be able to strike a complicated advanced pose, think of all the people who won’t even consider starting.
And I have learned to seek out modifications for those yoga poses that throw me off center. The old self-conscious me would have thought that made me a failure. But I know better now.
Because I know I can do the most important pose very well: sit quietly and breathe.
As we close out October, otherwise known as “Breast Cancer Awareness Month”, I wanted to share a video of a webinar about advances in the fight against breast cancer, offered through the Yale Alumni Health Network, led by Dr. Jamie Wells.
The speakers included Dr. David Mankoff (from UPenn) and Drs. Lajos Pusztai, Maryam Lustberg and Eric Winer (all from Yale) as they talked about research being done on hormone-positive, HER2 receptor positive and triple negative breast cancers. I’ve pasted in the Vimeo clip from Twitter, but also offer my simplified synopsis below. If you have the time to watch (~45 min for the talks, then interesting Q&As for about 20 minutes), I highly recommend the video!
— YALE ALUMNI HEALTH NETWORK (YAHN) (@YaleHealthSIG) October 28, 2022
In the midst of the discussions, it was heartening to hear that the doctors placed a lot of emphasis on both health disparities in different populations and also the search for treatments that would not severely impact a patient’s quality-of-life. These are two important topics. I appreciated that they acknowledged that we cannot make advances in the disease if we are leaving behind large numbers of people for whom treatment is inaccessible, and that a treatment is not viable if it successfully treats the cancer but damages the patient in other ways.
The best overall news is that since 1990, deaths from breast cancer have decreased by a third. That’s a significant improvement within the past 30 or so years, even though the prevalence of the disease is increasing. Dr. Mankoff noted that the survival rate improvements are due not simply to earlier detection, but also to advances in the treatments.
HORMONE-POSITIVE BREAST CANCER
Dr. Lustberg spoke about hormone-positive breast cancers and started with a quick explanation of the history of such cancers, and then explained how current-day personalized medicine (genomic profiling) can identify the patients who might be spared chemo based on the characteristics of their tumors, and how targeted therapies improve survival rates. She experienced some audio issues towards the very end of her talk, but not much information was lost.
She acknowledged that the “most effective drug is one you can take”, stating that there’s been an effort to try to understand the toxicity of various treatments. If the drug’s side effects are too negative, patients will have a hard time continuing to take it. She noted the importance of keeping the patient involved in the decision making process, something that all of us who have been through this can applaud. It’s too easy for oncologists to forget that they’re treating a human being who will be dealing with the concequences of heavy treatments.
HER2+ BREAST CANCER
Dr. Winer discussed HER2-targeted therapy, noting that prior to the year 2000, it was considered one of the most aggressive forms of breast cancer with common recurrences, after which the prognosis for survival was poor. As a HER2+ cancer suvivor, I am so thankful that this is no longer the case! The landscape changed with the introduction of monoclonal antibody drugs such as Herceptin, and the development of additional drugs, should Herceptin stop working, has given patients with this type of cancer much more hope for a full recovery.
Two of these new drugs for metastatic HER2+ cancer are “antibody drug conjugates” (T-DM1 and trastuzumab deruxtucan). Dr. Winer described them as Trojan Horses, as they can deliver the chemotherapy with which they’re paired directly into the cell, greatly decreasing side effects to the patient.
It’s so refreshing to hear the words “cancer” and “cure” used together in the same sentence. We are making serious progress now!
Perhaps most important, Dr. Winer actually used the word “cured” when talking about the outcomes for early stage HER2+ cancers, something that is truly remarkable. This is especially true for women with stage I cancers.
Many patients with stage II & III cancers receive the drugs prior to surgery, which can decrease the need for mastectomies and complete removal of the lymph nodes. In addition, pre-surgical treatment can guide the medical team in adjusting later therapies, based on how the tumor reacts to early drug administration.
Finally, Dr. Winer spoke of the stark disparities in cancer care, noting that black women are twice as likely to die from breast cancer as white women. Eliminating these disparities is his number one-rated area of importance for where to focus future efforts, something I strongly support.
TRIPLE NEGATIVE BREAST CANCER
Dr. Pusztai spoke of Triple Negative Breast Cancer (TNBC), and having lost several friends to this specific type of cancer, I was very interested in treatment advances that have been made. He described the differences beween TNBC and hormone positive breast cancers, noting that it’s likely that these two diseases orginated from completely different cell types, suggesting that these are different diseases and should be viewed as such.
It was exciting to learn that most of the patients with early stage TNBC disease are able to be cured (again, that beautiful word!). We now have both better treatment strategies and new drugs, and success rates are improving year by year. Dr. Pusztai emphasized the benefits of completing chemotherapy prior to surgery, going against our strong impulse to “get the cancer out” first. With the drug-first strategy, medical teams can adjust the post-operative treatments as needed.
The thing that was so amazing to me was that the recurrence-free rate of survival was 85-90% with these “modern regimens” for early stage disease. That’s impressive!
Next on the horizon is fine-tuning the right balance of drugs for patients, given that chemotherapies are still toxic.
There’s still a lot to be done, but all of this makes me feel so hopeful for a future in which a cancer diagnosis is something that we don’t have to fear.
Dr. Pusztai stated that he felt we already have the drugs with which to cure “at least some” of the metastatic TNBC patients, especially for those who are diagnosed at stage IV (rather than having earlier-stage disease that was treated and later metastasized). The idea is to utilize existing drugs but apply them using the new treatment strategies that have been developed. However, Dr. Pusztai stressed that new drugs are also being developed.
Q&As
There were a range of excellent questions that began at about the 45-minute mark, but as mentioned above, I enjoyed hearing the admissions by the doctors that they considered quality of life to be a very important factor in whether or not to continue medications, and they acknowledged that it is the patient who should have the control to balance their risks against their treatment options. Other questions included recurrence in hormone-positive cancers, development of drug resistance, genetic testing, continuation of care (“risk-stratified follow-up care”) and second opinions.
Dr. Winer commented that within a decade he felt we will have all the treatment we need to prevent and cure breast cancer in most patients, so again, he stressed that the focus must turn to making that treatment available to everyone, regardless of who they are.
LAST BUT NOT LEAST…
Dr. Winer admitted that many doctors, in treating patients, end up “taking over people’s lives and medicalizing their lives”. His approach, therefore, is “to try to provide therapy without making someone either unhappy or feeling like they are attached with a leash to their doctor’s office.” While there was some discussion related to this, I appreciated that doctors are actually thinking about this and want to allow patients to “live their lives”.
Finally, I was amused by the doctors’ admissions that even they found the drug names to be unpronounceable. It’s true that in my own treatment, I usually stuck to the easiest name to pronounce…I can’t imagine having to use those names on a daily basis!
I was going to write about something else for this week’s post until I realized that I had another five-year breast cancer anniversary to share: the end of my radiation treatment.
It had run for six weeks, five days a week — going to the cancer center became a daily habit. But on October 23, 2017, I rang the gong signifying the end of treatment, said my good-byes to the radiation oncology staff and left them with baked goodies.
Cancer treatment felt like a never-ending vortex of scary experiences…but it did finally end.
With 2022 being five years since my cancer diagnosis, I’ve had a number of anniversaries to share this year. What makes Oct. 23 significant is that it marked the end of all the “tough stuff” that people scare you with about cancer. By that date, I’d put the diagnosis, surgery, chemo and then radiation behind me.
Because 2017 had been a miserable year, when radiation was done I thought I could finally take a deep breath. I’d waited for this point in my treatment for a long time and decided that I would lose myself in the spirit of the holiday season.
The problem was, you never really get rid of all your concerns. You release some, but others show up to take their place. I finished radiation…but wait, there’s more! Now I was going on tamoxifen and that brought a whole new set of issues, and yes, fears, with it.
So I spent Christmas season doing my best to enjoy myself but the holidays passed by and left me feeling a little empty. I’d expected a lot out of them and they didn’t deliver.
I had wanted to be free of all my worries but that’s not how cancer works. In fact, that’s not how life works either. It took me five years to figure out that I couldn’t get what I wanted, but what I could make of it was beautiful in its own way.
Admittedly, it was a tall order. After cancer, I tought the world would shine with joy, but that wasn’t realistic. Cancer isn’t the kind of disease you say to, “done!”, brush your hands off and walk out the door. It tags along behind you, if not as the disease, then as its shadow.
Fast forward five years to now…ok, ok, I know what I got wrong back then.
I had felt like life owed me something amazing because it had put me through cancer. I thought I deserved a post-cancer life that was perfect. Of course, it wasn’t. And it still isn’t.
So if there’s something to celebrate, it’s that I learned a few things over the past five years.
This holiday season I’m not going to be expecting things to wow me. But I am going to be enjoying the fact that I am still physically active and working the same university job, expanding my horizons as a new yoga teacher and finding fun ways to spend my time. And mostly, that I have moved past the feeling of anger that I felt about cancer and found some gratitude to fill its space.
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I know I keep going on and on about how much better life is when you’re not carrying the burden of anger, but honestly, if I’d known that acceptance would lighten me up this much, I would have done it sooner!
Since we’re halfway through October – Breast Cancer Awareness Month – this is a good opportunity to remind everyone who’s had a cancer diagnosis that you’re still in control.
That might be very different from what you’re feeling. The whole thing with cancer is the sense that your life is out of control. Even your most faithful ally, your body, seems to be out to get you, growing a tumor behind your back.
Does it feel like someone else is controlling everything in your life?
That’s to say nothing of how your weekly schedule gets highjacked with oncological appointments, radiation treatments and days recovering from chemo. Then there’s the onslaught of new medical terms, the many pills that you’re supposed to take, even the practically unpronounceable chemotherapy drug names (what kind of a suffix is “-ib”???).
If anything, this might feel like the most out-of-control time of your life. When you’re slapped with a difficult treatment plan, you want it all to stop, but your oncologist tells you, “we won’t let you skip an infusion or stop taking your medication.”
That sense of being forced to do something (especially when it’s unpleasant) can open the floodgates to a deluge of anxiety on top of the fear and frustration that you might already feel about your cancer treatment. No one wants to feel like they have no say in a matter that affects them so deeply and personally.
This life is yours…and so are decisions about your cancer treatment.
But remember this: you always have a choice. Even though your medical team might not be phrasing it that way, you are still in control.
Perhaps this tiny acknowledgement may relax some of that perceived pressure and actually make it easier to continue. Your cancer treatment choices remain yours to make, so allow that realization to help you to step back, get perspective and weigh your options. When you demand space for yourself, you have room to think and it’s easier to act in your own best interest.
So, breathe. You’re still calling all the shots.
And, hey, medical team: maybe stop being so pushy and remind those cancer patients that they get to make the decisions about their treatment and their lives. It would go a long way towards helping your patients feel better about their treatment plans, like they’re part of the team instead of a prisoner of their situation.
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.
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 stability and grounding.
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.
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.
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.
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.
Frantic Shanti 