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.

When in doubt, keep moving.

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?

Wound a Bit Tight? Meditating with Muscle Release

I, like so many people, keep a lot of tension in my neck and shoulders. Some days it feels as though my neck is made of steel, but not in a good way.

The reality is that I don’t even realize how tight those muscles are until I lie down and try to relax.

So I have made a meditation of this for bedtime. Instead of focusing on the sensation of my breath, the focus is on releasing the tension in my neck and upper shoulders.

It may sound like I would not be able to squeeze an entire meditation session out of this, but oh, I can.

Complete release takes focus!

Lying down on my back I inhale, and then with the exhale, I focus on my neck and relax it, releasing the rest of my body along with it. With the following exhale, I do that again. That’s because while I may think that the initial release took care of the tension, there is still tightness there and I really have to work on it mentally to release that.

It’s as though my neck muscles are springs that I can stretch, releasing tension through the exhale, but once I let go (inhale) the “memory” in my muscles tightens them up again.

It helps to imagine my body melting, as if I’m being drawn downward into the Earth.

I can keep going like this, feeling my chin inch slightly towards my chest as the tension releases. Melting into the mattress. The more I release, the more subtle the sensation, yet very satisfying. The more I relax, the more deeply I breathe and everything lets go.

The awareness of what is going on in my body helps so much, but the tension is tenacious. This is not surprising, given how much mental weight my neck and shoulders bear. So it is a dance between releasing and returning to release again. Little by little until I eventually fall asleep.

The “Side Effects” of Yoga Teacher Training

I’ve shared that I recently completed a three-month, 200 hour Yoga Teacher Training (YTT).

My main motivation for entering YTT revolved around yoga’s role in my emotional recovery from cancer. My teaching goal is to make yoga accessible to more cancer patients and survivors. Sadly, the view that many have of yoga in the USA is that it’s mainly for young, white, flexible, affluent women.

That means that the benefits of yoga are not reaching many of the populations that need it most.

Sadly, yoga in the USA is not associated with a diverse clientele.

In YTT, I expected to deepen my own practice, immerse myself in the roots of yoga and gain experience in sequencing and teaching among other things. And we did that. The program was well-rounded and paid homage to yogic philosophy, in addition to covering a broad range of relevant topics such as anatomy, meditation, sound healing and creating an inclusive atmosphere.

What I didn’t expect was what I learned about myself. Now, in the course of cancer treatment I gained access to counseling at my cancer center with an excellent therapist. And prior to that, I had sought help for anxiety. I’d explored talk therapy, cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), mindfulness-based stress reduction (MBSR) and had gone through a lot of introspection. Basically, I thought I’d covered my bases and knew what’s what when it came to my inner workings.

YTT proved me wrong. I learned that I still struggle with competitiveness, perfectionism and a host of little insecurities. Wow, that was an eye-opener, even after all the “head work” that I’d done! In addition to coursework, YTT had a requirement of attending a number of yoga classes. Due to the limitations on my time given my work and family schedule, I was forced to take the heated (~95F) Level 2 classes, which happened to be most convenient. They emphasized balance and flexibility, while my non-yoga fitness focus has been strength and endurance.

*ahem* This is NOT me.

Balance and flexibility against the backdrop of neuropathy, menopause and vestiges of cancer treatment effects did not allow me to show my “best side.”

Not a big deal, I thought, since yoga for me is a mental “work-in”, not a workout. I’ve felt that holds truer to the traditional purpose of yoga and respects its roots. But in a crowded yoga studio where I was usually the oldest class member, I struggled to maintain my composure. Many of the other students could have been my offspring. The Level 2 classes made me look, I felt, like I didn’t belong.

And that feeling got worse as the classes went on. By the last weekend, I was the only teacher trainee who showed up (others trainees had more flexible schedules that allowed them to take other classes). After weeks of taking Level 2 classes, feelings of dejection had built up.

I should be over this, right? I should have been able to hold my head high and do what I could, knowing that my fitness stemmed from other activities and yoga served a different purpose for me than for “the youngsters”.

But nope.

The YTT itself was exceptional and the teacher trainers were amazingly supportive and knowledgable. The other members of my class were (no surprise) all white, all female and all younger than me. But they were generous and sweet and each one had been through her share of hardships. I felt only love from them. I just didn’t feel it from myself.

This is my preference for yoga: slow , mindful movements performed with intention. No contortions.

And with fitness being so important to me, I was frustrated that yet again I managed to find a situation where I showed myself to be “less than”. That was painful.

Yet, this peek into my current state was invaluable. Being in the midst of all those younger bodies strengthened my resolve to create classes that are more suitable for not only cancer folk, but also for other special and older populations.

YTT taught me that I don’t have it all figured out yet. However, it also gifted the awareness of what was really going on. Just as in mindfulness meditation, once I became aware of where my mind was leading me, I could take action to return to a place of peace and acceptance. That advanced my emotional evolution by lightyears!

Experiencing classes at a yoga studio also drove home the necessity of offering yoga to people who would benefit from the practice but are often forgotten when classes are planned. There are populations for whom studios are simply inaccessible financially, physically and even psychologically.

Ultimately, this next-level awareness showed me that what I had been doing on my own over the years still counted as yoga, even when I didn’t look like the other class members. It was the yoga I needed. And that was enough.

A Reflection on “Chemo Fatigue”

After posting videos from my final infusion where I described chemo fatigue, I felt it important to follow up with a debriefing.

I was not in a good headspace during that time. I had started a mindfulness meditation practice five months earlier but had too little experience and not enough training for it to significantly affect my mindset, 50+ years in the making.

When I write a cancer-related post, I straddle a line. On the one hand, I want to provide an admittedly subjective and honest account of what I experienced during treatment; on the other hand, understanding that we all come from different backgrounds and may have vastly different perceptions of what cancer means to us, I don’t want to color the reader’s view of what their experience might be like.

Cancer revealed a lot more about myself than I expected to find.

There have been times that I held back on projecting too much of my own personal state. I waited five years to post my videos on Chemo Fatigue because I didn’t know whether it was appropriate to do so. They remain some of the rawest and truest representations of the despair that I felt at the time. I was still very angry and frustrated, feeling what I recognize now as a deep sense of betrayal.

It was mindfulness meditation along with deep reflection, expert counseling and simply the passage of time that ended up bringing me out of the anger. That process took a lot longer than I ever expected. It also showed me aspects of my personality that I hadn’t understood before because I’d never had to confront them.

So while I still would never say that cancer had a positive effect on me, just as with many heavy life experiences, it took me to a new level of maturity and self-awareness. I am very thankful to be on this side of treatment, although I’m acutely aware that everything may change with the next scan. That makes every moment all the more precious.

Chemo Fatigue: What Is It Like? [video]

[IMPORTANT: Please be aware that at the time the videos were filmed, I was in a very negative headspace. My experience should not be considered an example of a “typical” experience because with cancer treatment, there is no such thing. Just as cancer is a disease specific to an individual, so is the treatment and, as a result, one’s response to it. If you are interested in viewing the below videos, please keep all the above in mind.]

I’ve posted quite of few photos of my cancer journey. You’d think I wouldn’t have any more pics left, but–surprise–I do!

I made some important (to me) videos after my sixth and final infusion, but to date I’ve hesitated to post them. In part, this is because I’ve tried to remain anonymous in this blog, but in the clips, you get to see my face. And it’s not a pretty sight.

I didn’t feel human.

I was the weakest that I’d been my entire adult life. My body was feeling the strain of multiple infusions of chemotherapy, I didn’t recognize myself in the mirror and my voice didn’t sound like my own. I was so sick and tired of this part of the treatment and wanted it to be DONE.

At this point, I wasn’t suffering that entire cascade of side effects that I’d experienced after my first chemo infusion, and I’d learned to better deal with what I did experience, and even what to do to avoid some of the side effects.

However, the fatigue I felt was far beyond what I imagined it would be. And it was coupled with constant background nausea, like a slow burn in my gut. This was a result of losing the rapidly-dividing cells that lined my intestinal tract; they were felled by the chemotherapy, collateral damage as the medicine killed off potential cancer cells.

Strangely, there were also times when I was actually quite hungry, but literally too tired to try to get something to eat. Even calling for a member of my family to bring me food required too much effort. Speaking took a lot of energy.

The final infusion’s side effects lasted the longest. A full week after my infusion I was still very unsteady and barely made it to work for a few hours.

It’s worth noting that this was pre-pandemic and I wasn’t properly set up for working from home. Were I experiencing chemo treatment now, I’d be able to get more work done…likely to my detriment, unfortunately, because I really needed that time away.

It took five years for me to decide that it was time to post these videos. Apologies if they get a little intense:

August 13, 2017 – Cancer fatigue, part 1
August 13, 2017 – Cancer fatigue, part 2