And Here We Go Again…

If there is a time that I’m going to feel anxiety, there’s a good chance it’ll be during my yearly mammogram. This year it came around the same time that my oncologist gave me permission to stop letrozole (and there was stress preceeding that appointment), but also great fear associated with my perceived cardiac arrhythmias, for which I have several visits with a cardiologist lined up.

Sometimes it feels like the stressors keep coming and coming.

To top that off, a family stressor followed on its heels, which I won’t go into but one that portends difficulties in the future. This last anxiety-provoking event used the previous stressors as a springboard and exploded into something even bigger. I was primed for anxiety and it took me for a ride until I found the traction to dig my heels in and slow down.

The worst part is, none of this stuff will simply go away.

Often, when people speak of anxiety-provoking events, they’re described as stressful things like a tense meeting with the boss or college finals or tight work deadlines. Admittedly these are all nerve-wracking, but they are also time-limited.

Then we have something like cancer.

I remember listening to a talk about anxiety where the lecturer tried to give the audience perspective about what was really going on, and he asked: what’s the worst thing that could happen? “You’re not going to die,” he assured us. And it’s true: let’s say that you fail all your final exams, but you’ll survive, even if you have to retake the classes.

Cancer survivors can attest to the fact that we suffer a different flavor of anxiety. There is no deadline on our stresses. They are thick and cling to us, like caramel sauce on the inside of a coffee cup, thinned by the passage of time, but leaving a film on our lives. Our hope is to get past the two-year mark, then five. Ten, if we’re so lucky.

Often, we hear about the success of treatments only to realize that the success is based on the majority of patients lasting until the end of the study, which might have been only five years.

Having someone tell you that you have a 95% chance of surviving five years is, well, underwhelming, especially for those of us who had premenopausal breast cancer. I mean, yeah, I HOPE I can last five years.

When you are here now, negativity fades to the background. Even if only for a little while.

So, what to do? If there were ever a time to practice non-attachment, this is it. For some of us (present company included), it is excruciatingly difficulty to release expectations–I want, even NEED, to be assured that everything will be okay and then rest easy with that.

But I promise you, clinging to the desire for things to be different only causes suffering. It also robs you of the joy of what you are experiencing right NOW–a beautiful sunrise, the softness of a pet’s fur, the richness of a cup of coffee, the coziness of a warm blanket. We are so wrapped up in fears of what the future holds that we miss the magic of what is before us.

Now is the only moment that exists, so truly, it’s the only moment that is real and certain.

Everything else is either history or what we concoct in our minds.

So this time of the year, I have to sit back and sense the Earth under my feet, feeling into how it supports me. This is what it feels like to be here now. No matter how many times I remind myself of this, I know I’ll have to do it again when the next stressor hits. That’s okay.

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This isn’t the first time I’ve written about anxiety and it certainly won’t be the last. But practicing mindfulness, every time I go through this experience, I reign in my emotions a little earlier and start feeling better a little faster. When I look back at what happened I realize I’m making progress, and that’s what really matters.

Just Do It: Breast Cancer Survivors and Exercise

Following up on last week’s exercise post, I wanted to focus on two recent studies that really drive home the benefits of physical activity for breast cancer survivors. If you’re not exercising now, here’s why you should consider it.

In 2017, Hamer and Warner published a review in the Canadian Medical Association Journal (Open Access link here). They analyzed 67 existing studies in an effort to ascertain what lifestyle factors were most important in reducing the risk of breast cancer recurrence in survivors.

Whatever you can do right now is enough to start out with. Just keep moving!

The results were striking: of all the lifestyle variables that the researchers looked at, exercise came out on top. They found that engaging in moderate exercise resulted in a 40% decrease in cancer recurrence. This included easily-adoptable, low-cost programs such as brisk walking.

I want to stress: they weren’t talking about doing crazy-high amounts of exercise, but simply adhering to the current physical activity recommendations for US adults, which are as follows (summarized by the American Heart Association and taken from their website):

Sadly, only 13% of recent breast cancer survivors actually met those exercise guidelines, and that number dropped even more as time went on. Consider how that affects overall cancer rates, when we talk about our chances as survivors: if the vast majority of the population is not engaging in a beneficial habit, the reported recurrence rates will reflect that. However, if you do incorporate exercise into your life, one could argue that your chances of recurrence are significantly improved over the numbers usually cited.

In addition, an increase of at least 10% of body weight after breast cancer diagnosis, which unfortunately happens often, increased both risk of recurrence and mortality. Again, patients who exercised were able to avoid this weight gain, improving their chances for disease free survival.

Nonetheless, while it seemed relatively straightforward to achieve the percent reduction in recurrence, the researchers stressed two very important points: (1) this reduction came after finishing treatments, not in lieu of them, so one should not assume that exercise would necessarily take the place of conventional cancer treatments, and (2) sadly, some cancers will recur even if the survivor is doing everything “right” and so if there is a recurrence, it should not be taken as the individual not doing enough. That’s the cruel unfairness of cancer.

It’s never too late to start, but it’s never too early either! Pick a sport and make it yours!

The second study was original research with high-risk breast cancer patients by Cannioto et al. (2020), published in the Journal of the National Cancer Institute (Open Access link here). The study participants filled out a questionnaire about their exercise habits at four time points: (1) when they enrolled in the study after diagnosis (this question asked about pre-diagnosis exercise habits), (2) during chemotherapy, (3) one year after finishing treatment, and (4) two years after finishing treatment.

Once again, exercise was shown as having a significant impact: women who met the guidelines for physical activity (150 minutes/week of moderate exercise) before, during and after treatment had a 55% lower risk of recurrence and 68% lower risk of dying than those who didn’t meet the guidelines.

Even those who only started exercising after finishing treatment still had a significantly reduced risk of both recurrence and death compared to those who didn’t exercise at all. Additionally, benefits were also seen for those who consistently exercised, even if they didn’t fully meet the guidelines. So it seems that any exercise that these high-risk cancer survivors did was still better than not doing anything at all.

The same holds for you!

Both of these studies convey the importance of engaging in physical activity. Exercise is critical for the well-being of all humans, but even more so for breast cancer survivors. Think: when we receive a cancer diagnosis, we are ready to undergo potentially dangerous treatments, risking debilitating side effects that leave us bald, exhausted and wretched.

So why not engage in something as beneficial for body and spirit as moderate physical activity to help prevent the possibility of having to repeat the cancer treatment again?

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A few more bits of information:

The easy-to-read executive summary of the US Physical Activity Guidelines for Americans can be found here.

For a plain-language synopsis of the Hamer and Warner (2017) review, see this Healio interview with co-author Dr. Ellen Warner.

For a plain-language synopsis of the Cannioto et al. (2020) paper, see this article in breastcancer.org.

Tailor your exercise to your abilities…and then keep going!

Keep in mind that terms such as “moderate” and “intense” are relative to YOU. someone just starting out is not going to be able to handle the same level of intensity as a highly-trained individual, and there’s nothing wrong with that. Start where you are–it’s okay.

Finally, Dr. Robert Sallis, chairman of the American College of Sports Medicine’s Exercise Is Medicine inititative, has said, “If we had a pill that conferred the proven health benefits of exercise, physicians would prescribe it to every patient and healthcare systems would find a way to make sure every patient had access to this wonder drug.”

The two studies here show exactly why!

When I Think I Don’t Have Time To Meditate

This being the last week of 2020, it’s a good time to write about establishing new positive behaviors. I myself am working on biofeedback practices to increase my heart rate variability, commonly referred to as HRV, and balance my autonomic nervous system (ANS) since I have a history of being very “sympathetic”-heavy (that is, “fight-or-flight”).

This is particularly critical for me as a cancer survivor since stress is closely associated with inflammation which is linked to cancer. So bottom line, I consider getting good at calming myself a matter of life or death. Most of my life has been a runaway train as far as stress is concerned.

To achieve this, I’m using a smartphone app called Elite HRV (but I’m sure there are others). In the biofeedback section, the app recommends two daily breathwork sessions of at least 20 minutes each. Now, that got me thinking about whether I had that kind of time available. As it is, come hell or high water, I meditate at least 30 minutes a day, often using a variety of apps and a mixture of guided meditation and breathing practices, in addition to informal meditation sessions.

“I just spend three hours doing WHAT???” Sometimes, when we’re busiest, we’re also most vulnerable to completely zoning out.

But adding another 40 minutes? Seems unlikely, since I’m often going from morning to night without much of a break, especially because my bedroom is also my COVID-office.

Still, is it really unlikely? Yes, it’s true that I’m working longer hours, but I’m still making room for non-work things that are critically important to me, like exercise. So I find time for what matters.

And if I review my workday, I know I experience periods of “zoning out”, often when something on my computer or phone catches my attention. These breaks aren’t long, but it’s not uncommon for me to get caught up in focusing on something else along the way…before you know it, that can be 10 or even 20 minutes.

And sometimes it’s really long. Case in point: over the weekend, my daughter and I ended up (and I seriously don’t know how we started on this, but…) watching several hours’ worth of YouTubers streaming video games. I don’t even play a lot of video games, but I was tired and became transfixed. And we did do this for several HOURS because one YouTube video often leads to another. That’s a chunk of my life that I will never get back, and in retrospect, that time could have been spent more wisely.

Now I realize that it would have been so simple to retreat to my bedroom for less than the length of one of those videos and eke out some quiet time to turn inward. I could have returned to the videos afterwards without feeling like I’d missed anything.

Leave yourself a reminder to pause activity and simply BE.

All I need is that little reminder, the mindful awareness that meditation and breathwork are available to me at literally any time. Even if it’s not a full 20 minutes. Five or ten minutes interspersed throughout the day will still offer benefits, so they’re still worth doing–and I’m talking about in addition to my regularly scheduled sessions. And who knows? Once I begin, I may find it possible to stretch those few minutes into a few more minutes. And a few more.

This is particularly important because as lovely as it is to have a longer calming meditation, the ultimate goal for me is to seamlessly incorporate mindfulness into my everyday activities, so that I am always able to take a deep breath and pause before my ANS gets triggered into “fight or flight”. It is especially those little blips of meditative time–a minute or two here or there–that help reset my nervous system.

Taking a mini-break for mindfulness may seem so simplistically obvious but I’m willing to bet that many of us don’t even entertain that possibility. We’re convinced we can’t shoehorn another thing into our busy days. If a sticky note by our computer reminds us to take five deep breaths, for example, and we begin incorporating that into our day, we see that there is more room for pausing than we imagined. Just opening up that breathing space can not only invite more consistent practice, but also slow the hectic pace of our lives.

We could all use that.

Online Classes: Yoga and Science – Putting It All Together

Please note: I’ve included links to various items below, none of which I’m compensated for. If I’m writing about them, it’s because I think they’re excellent and worth recommending to others.

In my never-ending quest to bring more peace into my life, and with the extra time I’ve found in COVID-19 lockdown, I’ve been taking advantage of online class on platforms such as edX and Coursera, and have been impressed with the breadth of courses that are available.

Currently, I’m mid-way through a class on Coursera from New York University (NYU) connecting yoga and science, called “Engineering Health: An Introduction to Yoga and Physiology,” and I am thoroughly enjoying it. This class can be audited for free, or $49 gets you access to the quizzes, a certificate once you’re done (that can be posted on LinkedIn) and no time limit on access to the materials.

The course is taught mainly by three individuals: (1) Prof. Alexandra (Ali) Seidenstein, lecturer and research scientist in the Chemical and Biomolecular Engineering Department at NYU, who is also a yoga teacher; (2) Eddie Stern, NYC-area yoga teacher and author, co-founder of the international Yoga and Science Conference and creator (along with Deepak Chopra, Sergey Varichev and musician Moby) of the highly-rated Breathing App for mobile devices; and (3) Prof. Tommy Lee, senior lecturer in the Chemical and Biomolecular Engineering Department at NYU. In addition, there are interviews with other scientists who have studied or made use of yoga in their research. For me, as someone who’s always looking for scientific validation, this combination of yoga and physiology is very gratifying.

First and foremost, the class teaches basic physiology. If you took survey classes in high school and college, the material will be familiar, and it’s presented in a clear manner with lots of visuals. Topics include physiological systems such as nervous, respiratory, cardiovascular, immune, digestive and much more. Additionally, there are discussions of homeostasis, epigenetics, and the effect of stress on human physiology.

As a cancer survivor, I find it so empowering to see the science behind how yoga affects my physiology, especially strengthening my immune system!

But woven in between all of these topics are instructions on breathwork and yoga movements for beginners, and this is what really ties the course together for me. The yoga is expertly taught by Eddie and Ali, both of whom make the experience very positive and not intimidating. With each lesson, they take the time to connect the physiology topics with what is being taught in the yoga class. This is a novel approach that I have found very empowering: there is a direct link between the work being done in the yoga lessons with functioning of the body.

For me, making that connection leads to a sense of self-efficacy and patience with myself, as it is with consistency of practice that we make change. Even more than that is the feeling that I can affect my immunity against disease (and cancer?) by keeping my stress levels in check. I have always felt that stress played a role in the development of my cancer, and although I cannot prove this, knowing that there is good science behind using such relaxation techniques as yoga and meditation in prevention of inflammation and subsequent disease gives me a sense of control in a situation that has often felt completely outside my control.

As mentioned, I am only at the midpoint of this class. I look forward to the second half and will report back about my overall impression once I am finished. In the meantime, if this post has piqued your interest, I highly encourage you to check the class out!

And Now We Wait…

Last Monday night my daughter and I noticed that we had sore throats. No big deal most of the time, but we’re in the middle of a global pandemic.

Of course, a sore throat can develop for a number of reasons. And we’ve been washing our hands, using hand sanitizer when soap and water aren’t available, keeping our distance from people. Nothing much to worry about, right?

Right. Except that it seems like a sibling of mine had actually suffered through an illness resembling COVID-19, with first symptoms appearing over a month ago, with a gradual onset. At that point, like many in the United States he wasn’t in a position to get tested (and with a fever of 103.9, he wasn’t about to drive himself to the doctor).

Now, I haven’t been in physical contact with him for about a year. But since I had a sore throat, I casually asked him what his symptoms were. I mean, I wasn’t exhibiting the same COVID-19 indicators everyone talks about.

Here we go again.

Apparently, his illness also started with a sore throat, no other symptoms for about a week, at which point the cough started. That was followed by a shortness of breath and fever, including two days that the fever was dangerously high. Eventually, the symptoms subsided, with the sensation of an elephant sitting on his chest, along with a lingering cough, being the last to go.

This would be extremely disconcerting to me, if not for the fact the sore throats that both my daughter and I had lasted only a few days before going away.

Phew, right? Well, kind of. Because if this had been COVID-19, we would have been dealing with the monster head-on. Now, we’re prepped for a fight with no opponent. Back to being vigilant, washing hands and crossing fingers.

Sound familiar? Any cancer survivor will tell you they’ve been down this road. It’s all about the waiting, trying to shed the anxiety about cancer coming back. Trying to shed the hypervigilance. There is no “end date”, there’s just an “I’ve made it this far so maybe my risk is decreasing?”

With COVID-19, we experience that lack of “end date” on a smaller scale. Eventually, there’ll be a vaccine. But we have no idea how long we’ll be waiting and how long our lives are going to be so drastically different. However, relief will eventually come and we can exhale.

As a cancer survivor, I’m kind of jealous.