Working Out the Brain Fog

So if you needed yet another reason to exercise before, during and after your breast cancer treatments, I’ve got one for you.

A recent study in the Journal of Clinical Oncology (Salerno et al., 2021) found that early stage (I-III) breast cancer patients who were meeting the US minimum physical activity guidelines both before and during their chemotherapy displayed better cognitive function then did those patients who did not, and the effects were apparent both at the time of chemo and also six months after its completion.

Cognitive impairment is a relatively common complaint of breast cancer survivors–and can be improved with exercise.

This follows along the lines of other things we already know about exercise and cancer, such as increased survival rates and reduced rates of recurrence. It’s not a big stretch to say that exercise (and for the purposes of this post, I’m referring to the US national guidelines) is possibly one of the best things you can do for yourself, whether you are already a cancer patient or don’t want to become one (again).

What are these guidelines?

It’s suggested that adults do (1) at least 150-300 minutes per week of moderate-intensity or 75-150 minutes per week of vigorous-intensity aerobic physical activity, or some combination of the two intensities, the more the better; and (2) strength training activity involving all the major muscle groups at least two days a week at moderate or greater intensity (see specifics at Physical Activity Guidelines for Americans, 2nd edition).

Notably, similar guidelines hold across age groups and health conditions, with some modifications, although what exactly constitutes moderate to high intensity for different people will vary according to their conditioning and abilities. Take home message: If you can’t meet the guidelines, do what you can. It will still benefit you. The worst thing you can do is nothing.

The benefits of exercise for cancer survivors have been well-documented.

While there’s been a considerable amount of research done on the benefits of exercise as a whole, we’re only now beginning to focus on cancer patients and survivors as the test subjects. And new research is being conducted on different aspects of exercise to learn what effects they might have on cognition.

I’m going to be watching for the results of two clinical studies regarding exercise and cognition of cancer survivors. Both are currently recruiting participants.

The first, being conducted by the University of California, San Diego, is entitled “I Can! Improving Cognition After Cancer” and will be a randomized trial that examines whether physical activity improves cognitive function. You can read about it here: A randomized trial of physical activity for cognitive functioning in breast cancer survivors: Rationale and study design of I Can! Improving Cognition After Cancer, funded by the National Cancer Institute. Want to learn more? Go to https://clinicaltrials.gov/ct2/show/NCT04049695.

The second, conducted by the University of Pittsburgh and entitled, “Aerobic Exercise in Improving Cognitive Function in Patients with Stage 0-IIIA Breast Cancer”, will explore the effects of aerobic exercise specifically and will involve neuroimaging and the examination of pro-inflammatory biomarkers. You can read about it here: https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCT02793921&r=1. Again this is funded by the National Cancer Institute. Interested in learning more? Go to https://clinicaltrials.gov/ct2/show/NCT02793921.

If you’re not exercising yet, the important thing is not what physical activity to choose, it’s to make the decision to begin.

If you have any interest in participating in either of these studies, contact info for the research project is available above in the posted clinical trial links.

So you might be thinking, “I can barely deal with the diagnosis…and you want me to EXERCISE???” I promise you, physical movement will only make you feel better. However, if you don’t have an established exercise routine and don’t particularly enjoy the experience, consider what you can manage.

We’re not talking about training for a marathon or a powerlifting competition. But if you can do something, ANYTHING, you will still see greater improvements in your cognition–and quite frankly, many other aspects of your physical and mental state–than if you hadn’t done any activity at all.

It is worth it and you are worth it. So lace up your shoes and give it a go.

Making Meditation Easier

So the recurring theme in my posts about meditation is the struggle that I have with maintaining focus. This has been complicated by breast cancer medications that are associated with cognitive effects, not to mention the eventual menopause and “brain fog” that has resulted from them.

And while I’ve taken all sorts of classes and scoured meditation how-tos, I used to wonder, am I even doing this “right”? Shouldn’t I have an easier time with this by now?

A recent “Daily Trip” contemplation on the Calm smartphone app, narrated by meditation teacher Jeff Warren, reminded me that it’s important not to overthink what we’re doing.

The breath is a wonderful point of focus because it moves through our body and elicits sensations in a number of places.

Often in mindfulness meditation, we’re taught to use different aspects of our breath as an “anchor” or point of focus. The breath is a nice anchor to use because it helps us move inward while still staying present. It’s also a moving target, so to speak, so it might be more interesting to watch (and therefore focus on) than a static sensation.

But people are different, and if it’s really not working for you, or if focusing on your breathing actually makes you feel more anxious, you can switch to another focal point. How about the sensation in the hands, the feeling of your body’s weight against the surface on which it rests, or the distant sounds around you?

Maybe you even use several anchors within a single meditation (consider dual focus). The idea is to remain present and aware of what is happening now, even if you have open all your senses in order to do so. What anchor(s) work(s) best for YOU? It is, after all, YOUR meditation.

What really matters is just that you make it back to the present.

And then, instead of worrying about maintaining focus, what if we let go of that? It’s okay, even expected, for your mind to drift off. I would argue that losing focus is an integral part of mindfulness meditation. Because it gives us the opportunity to be aware that we are no longer focused. And once you realize this, you have returned to the present. Nice job!

The more you practice this back-and-forth, like tossing a beach ball between your anchor and your errant thoughts, the more adept you will become at realizing that your thoughts have carried you away. The more you do that, the easier it will become to return to your anchor, and that’s the whole idea.

It doesn’t have to be more complicated than that.

When a Little Is Great but More Might Be Better: Exploring Longer Meditation Sessions

I am a believer in the idea that, for developing proficiency in an undertaking, consistency is more importat than what you do on any given day. It is true for workouts and it certainly holds true with meditation too. Exercises, whether physical or mental, need time to show beneficial effects and that requires patience and persistence on the part of the practitioner.

However, there comes a point where maybe what you’re doing, consistently, might need to increase in order to enable you to progress.

Consistency is key when it comes to exercise, both physical and mental.

When I started out with meditation, I had very little guidance outside that from the Calm app on my phone. The curated daily meditations there lasted about 10 minutes, so that’s how long I meditated. I did so ever single day, true to my perfectionist nature. I earned a gold star for consistency.

At that time, my life was in turmoil–I was only a few weeks out from a cancer diagnosis. Meditation helped me breathe through the early sleepless hours of the morning, when I would wake, feeling frightened, alone and angry.

But it wasn’t until almost a year later, when I started the Mindfulness-Based Stress Management (MBSR) course originally developed at the UMass Medical Center, that I learned how much meditation could do for me. Our “homework” was 45-60 minutes of meditation a day, no joke when you’re used to 10-minute stints.

But during that time, something unexpected happened. As I meditated, somewhere around the 20-30 minute mark, I felt myself settling in and releasing. This, for a bundle of nerves like me, was a novel experience. I don’t think I could have gotten that with 10 minutes a day. But a glorious hour? It was transformative.

Any meditation will do you good, but take advantage of those times that you can engage in a longer session.

Giving myself permission to simply BE for the entire length of time was not easy. There was guilt involved in being “unproductive” for so long, not to mention the difficulty of dealing with intrusive thoughts. But once my monkey mind accepted the fact that all I was going to do for the entire hour was feel into my breath or pay attention to bodily sensations, it started settling down, gifting me with a stillness that I hadn’t experienced during the shorter meditations.

It was the most soothing act of self-care that I had ever allowed myself to do.

So right now I want to clear the air of the “never good enough” idea, by which I mean the concept of, “Oh, you’re only meditating for 10 minutes? You should be doing it longer.” That is a total motivation killer and goes completely against the acceptance that mindfulness teaches. And that’s not what I’m suggesting at all.

There are great benefits to short meditation stints, one of which being that when you “drop and give 2 minutes” of deep breathing, or however else you choose to express your mindful self, you are actually doing a great job of integrating mindfulness into your everyday experience. Remembering to ground yourself in the middle of a hectic moment allows for a respite from the busyness of the day and helps build a mindful life.

But if you find yourself with extra time, such as a day of travel (where you’re the passenger!) or a prolonged sit in a waiting room–jury duty, anyone?–or even the decision to turn off the electronics and retire to bed early, it is well worth giving yourself a nice chunk of extended time to engage in the self-care of turning inward and being still.

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Tip: If you’re not used to prolonged meditation sessions, start with an extended guided body scan meditation, readily available free online through YouTube, MBSR websites and apps such as Insight Timer, for a few examples. It will give your monkey mind enough to do so that your thoughts don’t completely wander off, and yet little enough so that you can feel completely into each body part.

Cancer Info with a Grain of Salt

When I posted a couple of weeks ago about research that shows the potential benefits of melatonin as a cancer-fighting agent, I tried to emphasize that even though you can find a scientific study that suggest promise for a given treatment, that’s not enough to run out and take it yourself.

Your medical team still remains your best source of information. They’re not only reading and processing info from clinical studies, they also have the inside scoop on what actually works on a long-term level. Not to mention that they’ll be able to prep you for treatment side effects.

I was reminded of this by an article that appeared in Cancer Currents, a newsletter from the National Cancer Institute at the National Institutes of Health, entitled, “Addressing the Challenges of Cancer Misinformation on Social Media“. (Note: the National Cancer Institute has an information service you can reach out to with your cancer questions: Cancer Information Service.)

So you found some miraculous cure on social media. But if it sounds too good to be true, it likely is.

Unfortunately, people are turning to questionable sources–such as the oh-too-familiar Dr. Facebook or Dr. Google–for medical information. This has been glaringly apparent throughout the course of the COVID pandemic, but it certainly includes people looking for information for serious diseases like cancer. Often, the individuals most are risk of succumbing to “shocking cure doctors don’t want you to know about” misinformation are also the most vulnerable: those who are diagnosed with late-stage or particularly aggressive cancers.

Who can blame them? When things look desperate, we all hope to find some “secret” that has been tucked away somewhere. And that’s not without precedent, as there have been old drugs repurposed for a disease that work surprisingly well. So it does happen. It’s just that the first place that information pops up is not on someone’s social media page, and it’s extremely unlikely that the “cure” will be a special juice cleanse or your dog’s flea medicine.

Admittedly, I am intrigued by claims that pop up in less-than-scientific places. However, my first trip to the internet is to review whatever current research is available on the subject in the National Institutes of Health’s PubMed, and to see how reputable the journals are in which the studies have been published. Again, the Cancer Information Service would be an excellent resource for those who would like succinct info without wading through research papers.

No matter how tempting it may be to believe that some great cure is tucked away on social media, make sure you get your oncologist’s approval before you start any treatment.

Hands down, your best line of defense again bogus claims remains being a informed patient and educating yourself about what exactly makes a study trustworthy. Who is funding them? What does the methodology look like? A claim from a case study that blood cancers can be cured by rubbing toothpaste in your eye that appears in the National Enquirer and was funded by a toothpaste manufacturer…well, I don’t think I need to tell you on how many levels that’s a non-starter.

But for the sake of illustration, here we go:

  1. It already sounds fishy and harmful.
  2. “Case study” means that only one subject was studied, so the results cannot be generalized to a larger segment of the population.
  3. National Enquirer is not a reputable, peer-reviewed scientific journal.
  4. The funder of the study will gain financially from the outcome, which means there’s a confict of interest.

Certainly, the “study” above is an easy call. (For the record, I totally made it up, but if it sounds like something you might have seen on social media, well, there you go…)

But it’s not always that obvious. And often the info comes via well-meaning friends and family who are desperate to help. Please, consult with your medical team before you try anything out of the ordinary.

If you’ve honestly gotten to the point where you feel your team is not operating in your best interest, get a second opinion. If at all possible, change to a different oncologist.

But if the second (or third or fourth) opinion of a reputable and experienced cancer health professional echoes the original opinion, and no one is on board with the treatment you want to try…it’s time to ask yourself why you are so determined to go against the advice of experts, and reconsider for your own sake.

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It is unfortunate that many people hold doctors in contempt. As someone with a sibling who is a physician, I can promise you that most doctors do not enter the medical field because they think it’s a “get-rich-quick” scheme. They do it because they are driven to help people and they put in long exhausting hours under stressful conditions to do so. Again, if you feel that your doctor is not listening to your needs, then please seek out another qualified physician.

Melatonin As Cancer Fighter? Maaaaybe…

The last time I was researching the link between cancer and sleep, noting the myriad benefits gained from solid nighttime rest, I was surprised to see mention of melatonin’s role in decreasing the risk of cancer.

For anyone who might not be familiar with it, melatonin (a tryptophan derivative) is a naturally-occuring hormone secreted by the pineal gland that signals when it’s time to sleep and wake. It’s mediated by light levels, with the amount of melatonin in your body increasing as the sun goes down. You’ve probably seen melatonin on the vitamin shelves at your local store, as in recent years it’s been popularized as a non-addictive sleep aid. What I hadn’t realized was that its effect on cancer cells has become an active area of study.

I dug into the PubMed database to find there was quite a bit on this topic. However, note that not all the journals in which these results were published were familiar to me, so I cannot vouch for the rigor of the peer review, however, there was a general consensus that melatonin showed promise.

Melatonin shows a lot of promise as a cancer fighting hormone.

It’s well-established that women who work night shifts experience disruption of their circadian cycle and have an increased risk of breast cancer risk, purported to result from extra circulating estrogen (Cohen et al., 1978, Lancet). Researchers are now linking that disruption with a decrease in melatonin production.

Amin et al. (2019, J Cell Biochem) describe the action of melatonin as it relates to cancer: “Melatonin via its receptors and various second messenger pathways decrease[s] cell duplication and increase[s] cell differentiation.” Since cancer tumors are composed of a proliferation of poorly differentiated cells, this means that the action of melatonin works against the process by which cancer develops and progresses.

Amin et al. continue by noting that melatonin “regulates estrogen-dependent pathways (by nonreceptor-dependent means) and reduces the production of oxidants; as a result, melatonin inhibits cell toxicity and mutations….Melatonin interrupts estrogen-dependent cell signaling and also causes reduced estrogen-stimulated cells in breast cancer. [It] is a mammary tumor inhibitor…[as relates to the] development, progression, and metastasis of breast cancer via a number of molecular mechanisms.”

A randomized, double-blind, placebo-controlled research study showed that melatonin has a neuroprotective effect that can counteract the effects of chemotherapy on “cognitive function, sleep quality and depressive symptoms” (Palmer et al., 2020, PLOS One). These are significant side effects that have a profound impact on the patient’s quality of life, and anything that may relieve these will improve the entire treatment experience.

Griffin & Marignol (2018, Int J Radiat Biol) noted that melatonin administered to subjects before they were exposed to ionizing radiation resulted in the breast cancer cells being more sensitized to the radiation therapy, rendering it more effective. And melatonin seemed to reduce the radiation-induced side effects exhibited by both human and rodent subjects.

No matter how many drug treatments are available for cancer, they do no good if the cancer cells develop a resistance to them. In a study published this year, Sang et al. (2021, Cancer Lett) found that melatonin increased the effectivess of drug lapatinib in HER2 receptor-positive breast cancer cells that were originally resistant to the drug, suggesting that melatonin could be a promising adjuvant therapy for treating advanced HER2+ tumors.

So, melatonin may reduce breast cancer risk, make existing treatments more effective and help protect patients against negative effects of these therapies. Does that mean you should run out and gobble melatonin every night?

Many studies are first run on animal subjects, but to truly determine whether a treatment will be effective for cancer patients, it must be tested on humans.

No! As tempting as it sounds, that’s not an advisable course of action. Many more studies still have to be run to evaluate the exact mechanisms by which melatonin acts on physiological processes. Some of the results in the cited studies were based on small sample sizes; good for proof of concept, but following up with larger scale studies is critical. Some studies were run on animal models which are not the best human analogues. In addition, there’s little direction regarding proper therapeutic dosages. Establishing those will take additional research.

Keep in mind: a naturally-occurring hormone like melatonin likely has a “sweet spot” in terms of dosing, and determining the ideal amount may be tricky. Just because you can buy melatonin gummies in 10mg doses does not mean you should be taking that much.

Furthermore, melatonin may elicit negative side effects in some people, including headaches, nightmares and nausea. Side effects tend to be short-lived with short-term usage but there’s still not enough information available about long-term safety, so taking it for longer periods of time is strongly discouraged.

Note also, the articles I’ve mentioned above were selected because they describe recent research, although some of these are review articles that espouse the authors’ opinion, backed up by research selected for the purpose. If you’d like to read the above studies yourself and the links I’ve posted do not provide you full access, please consult your local university library for copies (copyright laws prohibit me from providing access to pay-only articles, regrettably).

Finally, it may be that some of melatonin’s benefits might be its undoing. Reiter et al. (2017, Int J Mol Sci) note that melatonin is inexpensive and readily available, and therefore there might not be the same level of interest in researching and developing it for cancer use as there might be with a novel drug with the potential to be more lucrative.

Where does this leave us?

I would urge you to:
1) Ask your oncologist about what they would recommend, given the research that’s coming out. They are still your best source for information. FranticShanti.com is only a blog and can be used as food-for-thought but definitely not for determining your course of treatment.
2) Learn how to read scientific studies. There are free courses on educational site such as Coursera.com that explain research design and interpretation in layperson terms. They can offer instruction on reading research with a critical eye.
3) Keep an eye on emerging research. Databases such as PubMed are excellent sources for health research. Even if you’re not well-versed in research design, you can look up articles to bring to your next visit with a health provider.
4) Do not take megadoses of melatonin! There is still so much we have to learn about this hormone as it relates to cancer, and self-medicating with melatonin in the hopes that “maybe it’ll help” is dangerous. Again, your oncologist remains your best source of information.

Promising drugs aside, get your sleep!

I do encourage you to respect your circadian rhythm by establishing good sleep hygiene practices to improve the conditions for your body to create and release its own melatonin. Proper and adequate sleep will always benefit you!

And so we get back to the idea that launched this post: sleep remains the ultimate good.

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It bears repeating: ALWAYS ask your cancer team about starting any new medication or supplement, regardless of how well-supported it is by research.

Before You Meet Your Oncologist, Be Aware…

…they don’t pull punches.

This is critical to be aware of when you’ve gotten your cancer diagnosis and are meeting your oncologist for the first time. We all go into that exam room fearful but hoping for good news. We want reassurance that it’s going to be okay.

The problem is, your oncologist can’t tell you that. They can’t say that you’ll get through this fine. Because they’re not going to promise you something they cannot guarantee. What they can give you is statistics. However, that may come in the form of something like, “You have an 85% chance of surviving…”, which sounds great, right, “…for 5 years.”

Is it good news or bad news? Their faces won’t tell.

Now, I don’t know how you feel about this, but honestly, when I heard that I thought, um, is that the best you can give me?

While I adore my oncologist, there was no cute wrinkled nose, no “I’m sure you’re gonna be okay” warm-and-fuzzies. It was all, “this is what’s next.”

I’m convinced that oncologists start their day by practicing how to deliver information without emotion, without giving away whether the news is good or bad. As patients, we literally hang on every word, every hesitation, every wrinkle on our oncologist’s face for an indication of just HOW bad the situation is. Some will reveal more than others, but in my own experience, it was “just the facts, ma’am” for quite a long time.

This could be very frustrating. I learned that I needed to get the “rah-rah” encouragement elsewhere.

On the plus side, however, I knew that if something was bad, my oncologist was going to tell me. He wouldn’t be like that friend who assures you your ugly outfit looks good just so that they don’t hurt your feelings. So if it’s any consolation, you’ll leave the office knowing what’s up, and what the doc doesn’t know yet if they’re still waiting for results. No false promises.

That helps get your head past the diagnosis and moving forward into treatment.

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I remember when, after my final infusion, I developed a horrible nail infection that landed me in the Emergency Room. I was stabilized, pumped full of antibiotics and my wound cleaned out. As I recovered, my ER doc came back to see how I was doing because he knew I’d just finished chemo and was familiar with the cancer experience. He told me that he was about to go notify another ER patient that they had liver cancer and wanted to take a breather and come talk to me before he had to break the news to them. It was obvious that he was moved by his patient’s plight.

So this was a great reminder for me that even though the doctors may seem to be stone-faced, they are by no means stone-hearted.

Grounding Through Mental Tracing

I’ve written before many times about different “grounding” techniques. Grounding is what helps move us out of the chatter in our heads and brings us into the present moment, where we can pause and realize that we are safe. It helps put space between our ourselves and both fears about the future and regrets about the past that may unnecessarily cloud our minds.

On days like those, I need to fine-tune my focus. This calls for a grounding technique that won’t be as easy to derail.

Body scans are some of my favorite grounding and calming go-tos. But recently, I was introduced to tracing the outline of the hand with your mind, a focus on just one part of the body. I tried this and found that it worked brilliantly!

As kids, we traced our hands to help us draw; now, it can help us stay present.

Just like when, as a child, you started a drawing using the outline of your hand by placing it on a piece of paper and tracing the around your fingers with a pencil, you can do the same thing mentally. Imagine the sensation of a point of pressure (say, an invisible crayon) moving up your wrist to the outside of your pinkie, around the fingertip, and down the other side into the hollow between the fingers…and doing the same as it moves up and down each finger until it ends up on the outside of the thumb and travels back down the wrist.

What makes this so effective for me is that it is a simple visualization that requires a bit more concentration, and yet it is still uncomplicated. That means that it gives my monkey mind a little extra to focus on, but not so much that it becomes a struggle.

Try it next time you need grounding and want to trying something different.

Kindness to Cancer Patients

REMINDER: Be nice to other cancer patients and survivors.

It feels weird to write that, because why wouldn’t you? So many of us who have had the cancer experience feel like we want to support and encourage those who come after us. We are driven to help. But that’s not always what happens.

Let me provide an analogy of sorts:

When I was pregnant with my first child, a daughter, I got an enthusiastic positive response from so many other moms. Everyone was ready with helpful tips and good wishes. At the same time, many also started in with stories of their own experiences, often times telling vividly about their struggles and pain and even, “Oh, girls are the absolute worst!”

Some experiences may leave us feeling “unfinished”, needing a kindred spirit to tell our story to. But we need to be aware of whose ear we’re bending.

Why would some women do this? I can only hazard a guess: perhaps because no one wants to listen to difficult stories. Childbirth is a momentous life event brimming with intense emotions that friends and family forget, but the mother in question holds on to because they are tied into so much of her. Her lingering feelings are brushed aside. No one else cares to revisit the labor pains or complications. As a result, tales of the experience are often not expressed until she sees another woman, a kindred spirit, embarking on the same journey.

So, too, with cancer. And it can be a difficult and awkward subject for many, cancer patients or not. Those of us who are breast cancer survivors may want to “talk about it”, and thankfully there are support groups for that. But friends and family may not understand the scope of the emotional fallout. We get comments like, “well, at least you got a nice set of boobs out of it,” and are expected to move on. Conversation over.

And then we see another woman going through this, and it’s difficult to resist inundating her with your own experiences and emotions, all in the name of letting her know that she can get through this, just like you did.

Does it help? Maaaaybe? But as we all know, everyone’s experience is different. What happens is that you’re not “preparing” her for what might come. You’re inducing anxiety in an already stressed-out situation.

I experienced this myself after my diagnosis, when, a week before my surgery, I ran into an aquaintance who had gone through breast cancer treatment several years before. And I know she was trying to offer support and make me feel better, but it didn’t. She made me anxious about my upcoming therapies, including ones that she not gone through herself. While my intent as a newbie was to share about my diagnosis because I felt that she would understand, I ended up being a sounding board for her concerns. Concerns that were valid, definitely, but not appropriate in the context of a very fearful cancer patient.

Offer support without taking over the conversation.

For the record, this was a lovely woman with whom I’ve had numerous subsequent exchanges. There was no ill-will intended. But it’s likely that she didn’t have many opportunities to speak to relate her story to other women, and given the chance, just needed to talk.

And I know that in my exhuberance to show support for other cancer patients, I’ve probably tripped over myself in an attempt to reassure too much. Offer too many hugs. While also trying to be noncommital about outcome. That’s a really messy combination.

So please, let us remember (and by “us” I mean myself!) that sometimes the best form of support for a newly diagnosed cancer patient is simply being there with them and holding space for what they may be going through. They will make their way through the experience, day by day, just like we did. There will be time to talk about the ups and downs of treatments.

But maybe not right now.

Grounding though Contact Points

Lately I’ve been speaking with people who are having a hard time dealing with anxiety, so I thought it would be worthwhile to dive deeper into grounding methods.

For me, hands down, strong neutral physical sensations (with “neutral” being the operative term here) are by far the best ways to pull my head out of swirling thoughts and get back to where I am now on the Earth.

Buttocks and feet are great focal points for drawing attention away from rapid breathing or heartrate.

Currently, I’m focusing on touch points: those places on your body where you are making contact with any surface. This is highly effective because it is well-suited for any situation. You don’t necessarily need to be in a particular position, nor do you need a quiet space. So if you’re in the middle of an exam, sitting in your boss’ office, standing at a podium or walking down the hallway of a hospital, this grounding method can shift you back to the present moment.

The idea is to focus on the sensation of pressure. My suggestion would be to bring your attention to whereever on your body you can sense that contact with a surface, giving preference to places further from areas that might be reinforcing anxiety, such as the chest region and a rapidly beating heart. So, hands, feet and buttocks would be good candidates. If you’re walking, then pay attention to the change in pressure of your steps as you put your foot down and lift it again.

Feel into these body parts, sensing how the pressure feels against them. You can also bring in sensations such as tingling and temperature. Like an investigator, experiencing these sensations as if for the first time, get curious about their quality. If needed, squeeze the muscles, but then make sure to relax them too, so that you’re not clenching. Then see if you notice a difference in sensation.

Try it right now. Go ahead, I’ll wait…

You don’t need a special place to practice grounding yourself. Where you are right now is perfect.

Did you try it? And did you feel anything? The type of sensation doesn’t matter here. The main goal is to get out of your head, which may be in overdrive. Paying attention to what your body is doing RIGHT NOW helps move you away from thoughts of dread and gives you a handle on your reactions.

Important: as with all calming techniques, this takes practice. It is not a one-time thing that you try, nor is it a pill that you pop and everything settles down. The more you practice this, especially when you’re in a peaceful surroundings, the better you will get at shifting your focus during times of anxiety. Just as with a formal meditation practice, it is consistency that will improve your focus and thereby your abilities.

The added benefit to practice is that you will realize you *can* do it, that it *does* work, and you will build confidence in yourself that you can handle it. So in an anxious moment, you’ll be able to say, “I got this” and bring yourself to a more manageable place.

“That Dragon, Cancer”: Catharsis in Video Game Form

I am always looking for ways to illustrate the complexity of emotions associated with having cancer, or caring for someone who does, as a means of relating it to people without this experience.

An immersive video game called That Dragon, Cancer does this by telling the story of a young child with the disease, in this case, a brain cancer called Atypical Teratoid Rhabdoid Tumor (AT/RT). The game explores the fear, hope, helplessness and fight that we go through when confronting so much uncertainty.

To be clear, this is not a video game in the usual sense, it’s a narrative with mini-game elements, sometimes lighthearted, sometimes dark. We follow the journey of a family as they navigate the rollercoaster of cancer diagnosis, doctor appointments and treatments. Those of us who have been on this path can relate to the tsunami of emotions and information, all rolled up into one overwhelming ball. The game does a good job of representing these feelings.

If you’re interested in experiencing this game with a blind playthrough, this is where you should stop reading. For more information on That Dragon, Cancer, visit the official website here.

WARNING/SPOILER: Because this is a true story, the developer Ryan Green (Numinous Games), along with his wife Amy, could not control the outcome; the game was created to honor the memory of their young son, Joel, by chronicling his battle with terminal childhood cancer.

Little Joel underwent a staggering number of treatments for his brain tumors.

Be aware that there are very distressing parts to this game. Just as cancer patients fight for meaning and claw for hope, so does this family. If you are not in the right frame of mind for this, or are at a painful part of your cancer journey, it might be best to skip this game. When the game originally came out in 2016, it left well-known YouTubers in tears. Everyone can relate to loss; Ryan and Amy made this even more powerful by documenting their son’s journey in recordings made during his treatments. Therefore, when you hear the distressed cries of a young child in misery, those are Joel’s actual cries, and they are heartbreaking. But hearing his delighted giggles helps ease the pain.

It is all very raw and real.

Even in the distress, we experience joy in the life Joel lived.

Losing hope, or clinging to it in the face of insumountable odds, is documented here. The Green family hopes for a big miracle, with Ryan and Amy each heading towards the outcome in different ways: Amy is adamant that Joel will be healed while Ryan is riddled with doubt. There is a very strong Christian influence in this game that reflects the Green’s religious beliefs, with many references to God, Jesus and saving grace through prayer, so those whose beliefs differ may find this element foreign and possibly irritating, and they should decide whether it is appropriate for them. Nonetheless, the game is beautifully done with moments that will make you smile in between tearful episodes and there is value in experiencing it.

Those who expect a movie-style, “deus ex machina” happy ending may be left empty and unsatisfied, but I found the end to be uplifting, inviting in the acceptance of inevitability.

The game also honors the memories of other cancer patients in imaginative ways.

I’ve now played That Dragon, Cancer three times through. The emotions that it evokes are very familiar and I found this game cathartic and validating. As the Green family discovers, if someone succumbs to cancer, it does not mean that their faith was not strong enough. If there’s one thing I’ve learned about this disease, it is that cancer is not picky, it doesn’t care about your desires and it doesn’t play by the rules.

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From the developer, Numinous Games: “An immersive narrative videogame that retells Joel Green’s 4-year fight against cancer through about two hours of poetic, imaginative gameplay that explores faith, hope and love.” $9.99 on Steam.