Practical Stuff – Page 18

Who Knew a Grapefruit Could Create So Much Confusion?

A few days ago, I decided to eat a grapefruit. We had gone to a Korean market earlier that day, and the citrus fruits beckoned to me with an enticing fragrance. I couldn’t resist.

So as I was finishing up one of the most delicious grapefruits that I’d had in a long time, I started thinking. Back when I was taking tamoxifen, I’d come across an admonishment not to eat grapefruit because it could interfere with absorption of the medication. But I wasn’t taking tamoxifen anymore, I was taking letrozole. Could the same be true?

I started googling, first on my phone. And as the search results came in, I had to switch to my computer because things were looking confusing. Many sites said “NO” in no uncertain terms. Grapefruit can prevent the letrozole from breaking down in the body completely, leading to higher levels remaining than could be safe.

It wasn’t that the grapefruit was hindering the efficacy of the letrozole, it was that grapefruit could set up a dangerous situation of “overdose”.

Of course, googling often results in messages that are big on warnings and short on details. So I dug further and happened upon forum posts where other women were asking the same questions.

I read the following exchange: one woman said she’d spoken to two different hospital pharmacists, both of whom had given her the okay to eat grapefruit. A number of other women (like, everyone else) chimed in on how they had unequivocably been warned to stay away from grapefruit (for the above mentioned reasons). The first woman reiterated that she had been told by HOSPITAL PHARMACISTS that she could each grapefruit with impunity…and so it went.

What really bothers me about this is that so many websites suggest that, it really it best to avoid grapefruit due to possible interactions with letrozole. But I slogged through the entire bloody informational insert from the manufacturer of my drug and NOWHERE did it mention that I shouldn’t eat grapefruit. There was also nothing on the bottle itself, nor did my oncologist say anything about that.

However, WebMD’s grapefruit interactions webpage, while not mentioning letrozole by name, did suggest issues with estrogen and also Cytochrome P450 substrates (of which letrozole is one, but I just happen to know that; others wouldn’t necessarily). WebMD’s letrozole info pages made no mention an issue with grapefruit. I mention WebMD mainly because many people consider it a reputable site and may go there for information.

If it truly is that dangerous to eat grapefruit while taking letrozole, why is that not explicitly stated on the container? Why would any woman think to google a random fruit or vegetable, like, “I think I’ll eat an artichoke and shiitake mushrooms today, but first I’ll do an internet search to make sure they don’t affect my medication.” Who plans their meals like that?

The bottom line is, the effect the grapefruit has depends on a variety of factors. It depends on when you’re eating and how much you’re eating, and how many days in a row. But all of that is so unsatisfying to me, who wants a concrete answer. Cancer is not about answers, however, it’s about getting comfortable with living with the unknown.

So, back to the grapefruit. Spooked, I skipped the medication that evening, although I’m sure I could have taken it and still lived through the night. I’ll ask my oncologist about it during my next visit, but I expect that his answer will be, “just don’t overdo it.”

And there’s another fragrant grapefruit sitting on the counter, which I will eat at sometime in the future, maybe half at a time. Here’s to living with uncertainty!

A New View of Stress That Can Save Your Life

I’ll be the first to admit that I have a history of not handling stress well.

A recent PubMed search on the connection between stress and proliferation of cancer didn’t help, as I found sufficient evidence to show that the two may be closely linked, and that is a disconcerting thought for a cancer survivor. Finding ways to relieve everyday stress has become one of my highest priorities. But would I be better served by focusing on stress as a positive force?

In her 2013 TED Talk, health psychologist Kelly McGonigal offers a new view of stress, not as a horrible experience, but instead as a state that primes your body for better dealing with hardships.

This is a novel and intelligent way of looking at something that, unfettered, could otherwise harm us. Why not turn it into a positive instead?

McGonigal points out that our attitude towards stress is critically important. A study from the University of Wisconsin (Keller et al., 2012, Health Psychol) demonstrated that people who experienced high levels of stress and were convinced that stress was harmful to their health were 43% (!) more likely to die during the eight-year study period. Note, these are correlational (not causational) findings, although it was striking how that belief predicted an earlier demise.

McGonigal describes research at Harvard (Jamieson et al., 2012, J Exp Psychol Gen) to discover whether changing someone’s attitude about stress can change their response to it. The study was designed to invoke anxiety in the subjects via a “social stress test”. But one group of participants was primed with information about how sensations associated with anxiety were actually beneficial for their performance: pounding heart = preparing the body for action; breathing faster = getting more oxygen to the brain for clearer thought.

Test subjects taught to reappraise their responses reacted differently to the stressors than might have been predicted. They felt energized, more confident and ready for the challenge. But what was even more surprising was that their physiological response was more positive, because they didn’t experience the tightening of blood vessels commonly associated with chronic stress and thereby with cardiovascular disease. Rather, the blood vessels stayed relaxed, as happens during periods of “joy and courage.”

What if effectively dealing with stress is as simple as changing the way you view it?

This is a much healthier physiological reaction. As McGonigal puts it, “How you think about stress matters.” It may make the difference between a long life and an early death.

McGonigal goes on to describe another positive benefit of a healthy stress response: the release of oxytocin, the “cuddle hormone”, which results in people seeking out social support during times of stress. Says McGonigal, “Your biological stress response is nudging you to tell someone how to you feel, instead of bottling it up.” In addition, this results in an increase of empathy so that you are more likely to help someone else who’s experiencing stress.

Further, oxytocin acts as an anti-inflammatory and protects the heart from potential negative effects of stress.

But most telling is a study (Poulin et al., 2013, Am J Public Health) that examined the connection between high levels of stress, risk of dying and amount of time that people spent supporting those around them. As might be expected given the above information,”people who spent time caring for others showed absolutely no stress-related increase in dying. …Caring created resilience.”

For me, McGonigal’s talk stood my belief about stress on its head. Can I learn to view the stress response differently? Yes, I believe I can. And what about social support? That is the path my life is taking: finding a more meaningful existence though supporting others.

This is a “win-win” of the highest degree.

“Don’t Drink the Water and Don’t Breathe the Air”: A List of Breast Cancer Risk Factors

After some intense research on the risk of developing breast cancer, I’ve come to the conclusion that the factor with the greatest causal relationship to the disease is, quite frankly, life. In fact, I sometimes wonder how people manage to NOT get cancer.

For your reading pleasure, I surveyed a number of reputable sites to compile a list of commonly accepted breast cancer risk factors (links to the info): American Cancer Society, Mayo Clinic, Memorial Sloan Kettering Cancer Center, Dana Farber Cancer Institute, Centers for Disease Control, National Breast Cancer Foundation, World Cancer Research Fund and WebMD. There are some emerging risks that most sites didn’t list and although I have seen the research studies in support of those factors, I opted to exclude specifics for now. Perhaps that’s for a future post.

Here you go, not in exact order of importance:

Being born female (well that covers about 50% of us)
Getting older (um, inevitable…)
Drinking alcohol (even moderate drinking has been shown to be harmful – find a different hobby)
BRCA1 and BRCA2 gene mutations, which everyone talks about, but certain mutations in the following may also increase cancer risk, although to a lesser extent: ATM, TP53, CHEK2, PTEN, CDH1, STK11, PALB2
Personal history of breast cancer (get it once and you’re a moving target)
Family history of breast cancer (including both close and distant relatives)
Personal history of breast lesions (even stuff that seemed benign-ish)
Radiation exposure, specifically to the face and chest, before the age of 30
Obesity (but mainly for postmenopausal women, see here; it’s complicated)
Having dense breasts (sometimes this is considered a top risk factor)
Beginning your period before age 12
Going through menopause after age 55
Having your first child after age 30
Never having kids (remember that when you’re paying for their college)
Taking hormone replacement therapy (HRT)
Certain hormonal birth control methods
Family history of ovarian cancer, especially before age 50.
Being white (at least in the U.S., although the rates of African-American women are catching up, often with a worse prognosis)
Having received diethylstilbestrol (DES) to prevent miscarriage, given either to you or your mother
Being inactive (honestly, exercise is critical – don’t overthink it – MOVE!)
Not breastfeeding (not only does nursing lower your risk, if you do get breast cancer, you’re less likely to get the aggressive triple-negative type)
Being taller (this may have to do with faster growth at an early age)
Doing night shift work (this may affect your hormone patterns, not to mention make you cranky during the day)
Smoking (the evidence for this has been deemed “suggestive, but not sufficient”, but inhaling smoke sounds like a bad idea regardless)
Exposure to cancer-causing chemicals (that’s, like, just about everything out there, and the connection remains unclear)
Diet choices (this is unclear, although there have been some links drawn to both macronutrient proportions and some vitamins, but more research must be done)

Oh, for the day when we can be guaranteed that what we’re doing is helping (or hurting) us!

In a word, we really don’t know, but living a healthy lifestyle gives you the best chance for survival.

Finally, the things that seem to have no reasonable link (per WebMD and echoed on other sites):

Antiperspirant (no need to stink)
Bras, underwire and regular (feel free to support yourself)
Abortion or miscarriage
Fibrocystic breast changes
Multiple pregnancies
Coffee/caffeine (raise your mug in celebration!)
Hair dye (unless it’s really radioactive, but come on, that would be silly)

Judging from the above info, it can feel like cancer is waiting around the corner to pounce on the next unsuspecting victim that wanders by. I thought I had ZERO risk factors, but I can easily pick out several there. At the same time, I know people who seem like they’d have a gazillion risk factors and they never get zapped. So.not.fair. But that’s cancer for you.

And the more we find out about the disease, the more we see how complex it is. We are all different, reflected by our DNA, so it’s not out of the question that we might be affected in unique ways by these risk factors. Research is uncovering new connections all the time, and it may be that in order to find a cure for cancer, we’re going to have to look at the disease in ways that we never have.

Pre- vs. Postmenopausal Breast Cancer Risk: There’s a Difference, But Does It Matter?

You’ve probably seen those plastic breast self-exam cards you hang on your showerhead as a reminder to feel for lumps on a monthly basis. I have one myself, and would read it over and over when I was trying to decide whether my lump was worrisome, reviewing the “reduce your risk” tips the card offered.

However, there are two points that I wasn’t aware of at the time that I was diagnosed: (1) we know little about causal factors, as most studies that examine risk are only correlational; and (2) there’s a difference between being premenopausal vs. postmenopausal when talking about breast cancer.

Okay, there’s a third one too: (3) risk factors don’t mean squat when I’m talking about my personal diagnosis.

First, a well-known fact: postmenopausal women make up the majority (approximately 2/3) of these cancer cases, so it’s not surprising that the focus is on them.

I, however, was premenopausal when I felt the lump in my left breast.

Imagine my surprise, then, when I learned that while being overweight or obese is a significant risk factor for postmenopausal women, being overweight as a premenopausal woman seems to offer protection against the disease. Whereas I thought I didn’t have any risk factors for breast cancer, as suggested by that plastic card in my shower, perhaps I did.

There’s not much talk about that protective element of weight for premenopausal women. You would be hard-pressed to find a popular website that mentions it. And no doctor would encourage a premenopausal woman to carry extra weight on the off chance that it might lower her risk of breast cancer; it’s too much of a liability for other health issues, including other cancers.

This explains why, if you’ve gone to a gathering of newly-diagnosed breast cancer patients, you’ll see some younger, remarkably fit women looking a little dazed and wondering what they’re doing there.

The weight risk factor is often posed in the following way (from the Mayo Clinic site): “Overweight and obese women have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause.” Well, that’s not wrong, but it doesn’t tell the entire story.

Harvard Health Online puts it differently, with a caveat: “Being overweight or obese has been linked to breast cancer risk, especially for women after menopause, but the relationship is complicated. It may be that risk is increased in women who gain weight in adulthood but not in those who’ve been overweight since childhood.” That seems even more confusing and less reassuring.

It’s true that everything about cancer is complicated. If it were straightforward, we would have found a cure by now. Furthermore, when it comes to guidelines to follow, people don’t want details, they want sound bites. But simplification cuts out information. For example, this CDC webpage about what you can do to lower your breast cancer risk posts recommendations geared for older women, including maintaining a “healthy weight”, but the photo that’s shown is clearly of two younger women.

Even a cursory glance at the research reveals what a difference menopausal status makes. In addition to extra weight seeming to have a protective effect in premenopausal women (Cold et al., 1998, Eur J Cancer; Lahmann et al., 2004, Int J Cancer), it’s also been determined that greater red meat consumption in adolescence is significantly associated with increased risk of breast cancer in premenopausal women (Farvid et al., 2015, Int J Cancer). Interestingly, higher quality diets have a more beneficial effect on the risk of postmenopausal women and seemingly no effect on premenopausal ones (Haridass et al., 2018, J Nutr). I would expect that a more exhaustive search would yield even greater differences.

So what does this tell us? This is less about the specific differences between pre- and postmenopausal breast cancer risk, and more that there simply is a difference. At this point in our knowledge, we are still putting together pieces of the cancer puzzle.

Additionally, many studies that offer preventative guidelines are based on other studies–they may be meta-analyses of previously collected data from a broad range of subjects. The data may be self-reported, which may result in recall error. And when you have a sample size of ~30,000 women, you’re talking about general risks for populations, not a specific risk for a specific, and very unique, individual: you.

All this sounds exasperating, but one concept holds true: no matter what your risks, the healthier you are before you’re diagnosed with cancer, the better your outcome compared to someone with less healthful habits, should you get the disease. Instead of obsessing about possible risk factors, give yourself the respect you deserve–put the effort into improving lifestyle habits to grant yourself the best chance for survival. In the end, that’s what matters.

Falling Back Asleep: Nighttime Relief

As calm as I may be during the waking hours, nightfall poses a unique challenge. How many of us have struggled in the darkness, surrounded by those scary thoughts that we thought we had dealt with during the day?

The darkness seems to make us more vulnerable to flying thought-gremlins. They creep in at night when our brains can’t reason them away. I’ve fought those little buggers for much of my life and they’ve been responsible for many hours of lost sleep. It wasn’t until I got serious about meditation that I developed means of protecting myself against them.

These are my best recommendations for returning to dreamland:

Drop into your bed. After waking to Dementor-esque anxieties circling you, realize that they’re flying, ephemeral creatures. And if you’re up there with them, it’s time to come back to Earth and settle into your bed. That is where you really are and you are safe. Focus on how it feels to have your body contact the bed, how the bedclothes feel against your skin. Rustle the sheets and listen to the sound. Take three deep breaths and listen to the exhales. You’re not “up there” with the swirling thoughts. You’re down here where it’s calm.

At times when there’s too much noise in my head, I will put a soothing voice in there from a meditation app like Calm, Plum Village or Insight Timer. Sometimes a guided meditation is enough to quiet the negative clamor.

Practicing stress release during the day will make it easier to do the same at night.

To support nighttime attempts at falling asleep, establish a sense of calm during the day. Practice being present — as opposed to chasing thoughts down rabbit holes. Pay attention to your reaction to various stimuli. Take conscious breaths, meditate, and use whatever tools work for you.

For instance, I have associated certain images with a calm state and I use them as anchors during the day (e.g., setting up a safe space). I have them pinned up by my bed and at work so that as I work to release stress I look at them, and as I look at them I release stress. The more I do this, the more powerful the association. I draw upon those images and feelings at times when things seem out of control. Practice during the day and you will have more peace at night.

Appreciate the nighttime wakening. Odd as it may seem, this can be a positive opportunity. Each such interruption allows you the chance to ground yourself and learn how to gently drop off to sleep. Stressing about being awake does you no favors and only adds to your wakefulness.

This doesn’t mean that there aren’t bad or frightening things actually happening in your life — sometimes there are and they can be very serious. I struggled with this when I got my cancer diagnosis. But at that moment in the middle of the night, lying in your bed, you have a temporary reprieve. Your only responsibility then and there is to go back to sleep. There’s nothing on fire.

Unless there really IS a fire, in which case, RUN. But most of the time, it’s just our fiery thoughts. And we can learn to douse those flames.

This will take practice – it’s not a one-time pill. But once you have done this enough times, you’ll find that not only is the relief wonderful, so is the knowledge that you are capable of determining how you react to things. That provides a satisfying sense of strength and a peaceful sense of control over what may seem like an out-of-control situation.

“Dropping Down”: A Meditation Analogy

One of my greatest obstacles to meditation is distraction. I’m particularly susceptible to having my mind wander off because of the drug tamoxifen that I’m taking for breast cancer, the side effects of which include difficulty with concentration and focus.

A wandering mind, however, is not limited to those with cancer medication side effects. If you meditate, you’re pretty much guaranteed to struggle with focus at some point. I use the analogy of a cave to describe what this feels like and how to deal with it.

I sit in a darkened cave, warm and comforting, the only light coming from a hole far up above, where the noisy world buzzes. There’s nothing wrong with that, but right now is the time to devote to my meditation cushion. I focus on my breath. As I sit, a thought emerges and I notice a rope hanging down from above. Before I realize it, I’ve grabbed hold of it and start climbing.

These thought-ropes are so tempting to grab onto, pulling us up and away from the meditation cushion.

The further I climb, the easier it is and the louder the world gets. My surroundings brighten, but I’m no longer meditating. I’m actively engaged in what’s going on up above, perhaps agitated, perhaps excited. I’ve lost track of my breath.

“Drop down,” I tell myself gently. And I slide down the rope, into the welcoming darkness below, until I find my place back on my cushion in this womb of Earth. One deep breath and I’m grounded again, calm and rooted.

I can’t stop what’s going on in the world above, but I can choose whether or not to climb a rope.

This experience repeats itself, like a flowing dance between the meditative breath and wandering attention. Another thought catches me and I reach for its rope, making my way back up swiftly.

“Drop down,” I tell myself again patiently. I let go and return to my place in the cave, surrounded by the supportive darkness. Another deep breath and I’m calm again.

So many thoughts, so many tempting opportunities to climb out of my cave too soon. Some days, I swing from rope to rope, only hovering over my cushion, never quite managing to ground myself. On other days, it’s easier and the path to a peaceful meditation session is straightforward. The darkness of the cave soothes me and reminds me that I am safe, and that I can choose whether or not to cling to a thought.

My distraction is a constant, but that doesn’t matter as long as I can drop back down. And I can always drop back down.

Making Peace with Street Noise

Is it possible to re-imagine annoying city noises?

At the least, living in an urban area with a high level of noise pollution is annoying. At worst, being subjected to car alarms and emergency vehicle sirens at any time of the day and night is very jarring and stressful. And I’m speaking from personal experience here, as following our last move, we ended up with a bedroom overlooking a very busy Southern California street.

The stretch of road outside our apartment unit is one of those that give cars enough distance between traffic lights to really accelerate as they blast by. It also leads to one of the major hospitals in the area (hello, ambulance traffic), and this being a big city with big city issues, there’s no shortage of opportunities for the police to be called out, sirens blaring.

There are many days that I wish I weren’t where I am. But wishing doesn’t change anything.

Drawing on mindfulness helps, however, and this is how:

Re-interpreting noise as different sound elements turns an “idiot street racer” into a thunder-like rumble. Much less annoying.

Much of the stress I experience from these various car noises is due in part because I know what they mean. I know that the sounds are the constant stream of cars going down the street or a high-pitched siren wail. But what if I were to accept that I’m living in a noisy city and to define the street noises as simply various sounds?

What if I were to break down the sounds into their characteristics? Would it be easier to handle the noise if I stopped judging and explored each sound as if I were hearing it for the first time?

This is far more doable than one might imagine. Yes, alarms and loud tail pipes are decidedly unpleasant, but they don’t punctuate my soundscape nearly as frequently as do the regular cars driving by. The cars speed through with whooshes of different pitches depending on the vehicle and how quickly it passes.

Sounds of passing cars transform into soothing waves – with the occasional jarring reminder that things are not entirely pleasant.

These sounds rise up and pass away like waves on the ocean – in fact, that whoosh can be soothing, just like the sounds of the ocean can lull you to sleep. Even noisier cars and motorcycles take on a rumbling quality, like thunder. Allowing oneself to re-interpret these sounds, to let go of annoyance, makes even the more jarring noises easier to handle.

When you can’t run away from the noise, make space for it, invite it in and accept that this is what’s happening now. Inevitably, it will pass, to be replaced by another noise and another opportunity to re-imagine it.

Sanctuary: Creating A Safe Space

There have been times when things in my life have gotten intense and I feel the walls closing in on me (cancer, I’m looking at you). Those are the times that I need to back off and give myself space to breathe. Being a very visual person, one of the methods I’ve employed is finding an image and associating a calm mind with it.

This becomes my safe space. Whether you prefer to call it your “calm space”, “sacred space” or even the oft-ridiculed “happy place”, the idea is the same. Find the visual elements that you find soothing and comforting — perhaps a place in nature, a place from your past where you felt safe, even a fantasy land that you create for the purpose. Real, imaginary, familiar or visited only in your mind, it doesn’t matter. What matters is that it resonates with you.

When I did this most recently, in the preparatory phase for Eye Movement Desensitization and Reprocessing (EMDR) therapy sessions to help with anxiety that I’d never been able to shake, I made a new Pinterest account to collect images.

I highly recommend this for anyone going through stressful times. We all need a buffer between ourselves and this hectic, unpredictable life, and this is one way to do that. Collecting and pinning these images is relaxing in itself!

I have always been drawn to natural settings with lots of greenery, so I searched for elements such as gardens, greenhouses, water, hanging vines, flowers and fish. This is a place created exclusively for me.

As if from another time, this space offers vines, a beautiful pool, elegant architecture and the feeling of a hideaway. https://www.pinterest.com/pin/701998660650066569/

It is is easy to find many images that capture the feeling I’m after: a sense of closeness and security in a place of natural beauty, where I can be alone (unless I chose to let someone else in), a space impenetrable from the outside.

There’s nothing quite like watching koi to bring peace to your day: https://www.pinterest.com/pin/701998660650161590/

The sound of running water is luxuriously soothing, and the vibrant color of koi brightens everything. The above image may have been at the side of a house, but in my mind, it could be a hidden corner that only I can access.

A beautiful path, lined with flowers, that gives the feeling of being tucked away in an elegant and exclusive setting. https://www.pinterest.com/pin/701998660650067012/

Not all spaces have to be confined, as this vine-covered path above illustrates. It provides room to wander and breathe deeply while still feeling secluded.

This could be the magical entrance to your fantasy space: https://www.pinterest.com/pin/701998660650254229/

Your calm space can be made up of different images that show different elements of it. Each space needs a portal through which you enter, so why not make it magical?

It might be enough to have a safe area from which you can look out onto the world, but still feel secure in a colorful, fragrant setting: https://www.pinterest.com/pin/701998660650066950/

Once I had gathered a variety of images that evoked the feeling of grounding and peace that I sought, it was time to name it: one word (or phrase) that enables me to conjure up my calm space. I settled on Halcyon, but realized later that it didn’t give me what I needed (I’m picky about words and their meanings). Then I came up with Elysium, as it suggested an other-worldly place in the heavens.

I thought that name fit perfectly. Except that as we continued in the preparation phase for EMDR, I had a hard time maintaining focus on one particular image. I had chosen so many! So I thought about what I really needed.

It was breathing space. A place to pause when things come at me too quickly. Ironically, after pinning so many glorious images on Pinterest, I returned to a photo that has served as the background for my two monitors at work. When I arrive in the morning and log in, this image grounds me and I find myself taking a very deep breath, like a sigh:

This image speaks to me. It combines nature with a sense of spaciousness, yet feels secluded enough to impart a feeling of security. And my name for it? Sanctuary. So simple and to the point, and yet encompassing so many different emotions and meanings for me.

The next step has been feeling into the sensations that this calm space evokes. What does that feel like in my body? And then holding onto that feeling, saying the name, imagining the setting. You can “charge” the image with meaning in this way ( à la Pavlov).

The associations that are formed in the process create a sense of calm that I can draw upon to center and ground myself during periods of high stress. It’s not a pill to end all woes, but it can be a powerful tool for dropping yourself down into a more peaceful state. I encourage you to give it a try.

Two Assumptions I Wish Doctors Didn’t Make About Cancer

Cancer can turn you into a stress-ball on its own, thankyouverymuch, but there are things that healthcare workers do that may worsen matters.

While there is always room for improvement in the many subtleties of physician-patient interactions (with subtleties being the operative term here, as anxious patients may be zeroing in on the “feel” of interactions and not just the spoken words), there are two big assumptions that I wish doctors would realize that they’re making:

Eat your vegetables and you won’t get cancer? I wish it were that simple.

The first assumption I’ve experienced has been made by non-oncologist physicians. They seem to be just as likely as the rest of the population to confuse correlations with causations. One doctor had been surprised that I had gotten cancer (hey, join the club) because my lifestyle “should” have been protective.

This physician, you could argue, was justified in saying what he did, as the messages we are bombarded with suggest that we have some control over our risk for cancer. However, read the fine print and you’ll see that in a great number of cases the risk factors that a cancer patient has don’t differ from those of someone who doesn’t develop cancer. But even doctors miss the fine print…

I brought this up to my oncology team which was quick to point out that as long as we don’t definitively know what causes cancer, we can’t make assumptions about whether or not someone will get the disease. So, yeah.

The other major assumption is one that I’ve gotten from the oncological community, and that is that on some level, most patients with a given cancer have the same health profile. Ironically, this concept is often mixed in with the conflicting assertion that everyone’s cancer experience is different. Granted, when you’ve seen a gazillion cancer patients, similarities emerge, and consciously or not there’s probably a tendency to pigeonhole people. Still it’s frustrating to be treated like I fit into a slot when I really don’t.

Effective communication is a critical part of quality physician-patient interactions.

My own oncologist has realized that, thankfully, but he has done a good job of listening and I do a (*cough cough*) good job of talking. Perhaps a bit too good, since he’s mentioned that it would be best if I scheduled my appointment to be his last of the day, so that we don’t face as many time restrictions. But therein lies my point: oncologists need to ask and patients need to share, otherwise, the patient remains a two-dimensional entity and it’s more likely that assumptions will be made about them.

So if there’s a take-home message from any of this, it’s that good communication is an essential part of effective treatment. This is not an easy feat, as physicians have a limited amount of time with each patient, and patients might not think that a given aspect of their experience is relevant. Believe me, it is, and the more that we talk about this and get into the nitty gritty of it, the easier it will be for everyone involved.

How Mindfulness Helps with Exercise Motivation

Exercise has been an integral and indispensable part of my cancer recovery and my life as a whole. I’ve maintained a personal trainer certification (ACSM-CPT) for over a decade and even though I don’t train professionally, I keep abreast of new research and love a challenging workout.

Still, there are days that even I find myself dreading the session I have planned. For those times, I engage in mental calisthenics and rely on a mindful attitude. If you’re struggling to find motivation to exercise, this may help you too.

Note, motivation is something you generate yourself. It is inside you, but you have to coax it out. Be gentle. Hiring a personal trainer to beat you with a stick when you’re not up to a workout is not going to make you look forward to exercising more. But the following concepts might help:

Consider that a workout is made up of a series of movements.

Stop looking at a workout as a massive monolithic thing. Doing so can be overwhelming and make it more likely that you’ll talk yourself out of it before you even begin. Instead, consider that it’s made up of distinct parts, steps that you take one at a time.

Stay in the moment and keep each movement fresh.

Stay present and focus on the part of the movement that you’re doing at the moment, truly feeling into it. If you’re on a rowing machine, concentrate on each individual stroke making sure that you’re using proper form as you reach, push with your legs, and pull the handle. If you’re lifting weights, focus on where your body is in space, on contracting the muscle as you lift, on exhaling as you do so, keeping your body properly aligned. If your exercise is a brisk walk, be aware of how you’re stepping, pushing forward, swinging your arms. These movements become a meditation in and of themselves.

What matters is the here and now.

Release thoughts of how much longer you have until you’re done. Focus on the stroke, step or rep that you’re taking at this very moment. And then when you’ve completed it, consider the next movement with the same fresh attitude. Just as you would if you were focusing on each breath during meditation.

If you can’t finish your workout, that okay. You can try again tomorrow.

Practice self-care.

Do not force yourself to finish an entire workout if you *really* don’t have the energy to–but that means truly listening to your body’s limitations, not discouraging voices in your head. You are better off making a concerted effort at doing, say, half your distance or only one set per weight lifting exercise and doing it well, instead of making yourself so miserable that you don’t exercise again for another week and a half.

If you’re thinking, “I’m not up to doing the entire workout”, ask yourself, “Well, how much can I do?” and at least start. Consistency is key.

Let go of expectations.

Release preconceived notions of how your workout will go and how tired, miserable or sore you’ve already decided that you will feel. Look at each movement with fresh eyes. Employ a beginner’s mind. Get curious about how everything feels.

While it’s true that you’re exercising your body, your mind has a lot of influence on what will happen. The kind of exercise session you have is up to you. Decide to use your best form, draw on as much energy as you have in the moment, and exercise as much as you have planned. And if you cannot go as long you anticipated and have to stop earlier, let that be okay. No matter how much exercise you do, you are still better off than having done nothing. No one can take that accomplishment away from you.

And tomorrow, experience it anew again.