Working Out to Avoid Freaking Out

It’s hard to imagine a cancer diagnosis that doesn’t provoke some level of anxiety.

When I was told that I had breast cancer, it didn’t take long before I got a prescription for Xanax because my anxiety was going through the roof — I clearly couldn’t handle everything I was feeling. It wasn’t until my radiation oncologist suggested that I try meditation that my view of the best way to handle my anxious feelings changed, and eventually I dropped the Xanax altogether.

But one thing that I kept on doing was exercising, at least as much as I could manage on a given day. So after reading a recent study about exercise, I had to wonder how much worse my experience might have been if I hadn’t kept to my workouts.

Henriksson et al. (2022, Journal of Affective Disorders; see link below) found that engaging in moderate or strenuous exercise was very effective in relieving the symptoms of anxiety. What I found so interesting was that half of the study participants had actually lived with anxiety for at least a decade, and they still got relief!

The subjects in the exercise groups did a combination of both strength and cardio training.

The subjects in the experimental groups were assigned to one of two groups: low-to-moderate intensity group exercise or high intensity group exercise. The exercise was timed circuit training that combined both cardiovascular and strength moves and subjects maintained heartrates at levels appropriate for their assigned intensity levels. At the end of the 12-week program, everyone’s anxiety had significantly decreased, as compared to a control group that was not participating in group exercise.

What is striking is that there was a tendency for the improvement to follow the level of intensity; the harder the subjects exercised, the more anxiety relief they experienced. Talk about motivation!

My own experience echoes this, but in a subtractive sense. At times of intense stress, my anxiety skyrockets when I’m prevented from engaging in my regular workouts. This may happen, for example, when I’m dealing with an unreasonable workload that ties me to my desk and preempts my exercise sessions.

I used to wonder why I felt so much worse when I was getting more work done. This study answers that question for me.

Couple these results with what we’ve learned about the beneficial effects of exercise in decreasing the risk of recurrence of breast cancer and it is incredible why physicians don’t write exercise prescriptions for their patients, and why personal trainer sessions are not covered by health insurance.

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There are several things that I feel are important to underscore here if you’re interested in trying this out yourself.

The social aspect of the exercise sessions may have also played a role in alleviating the anxiety that the study participants had initially complained of, and there was the added benefit of a pre-planned, supervised program.

First, this was a group session. That means that there was also social support involved as no one was exercising alone. The subjects were supervised by a physiotherapist; they didn’t have to come up with their own program, as it had been created for them.

Also, the exercise included both cardio and strength exercises and included warm-up, cool-down and stretching, so it covered all the bases, so to speak. And the subjects got fitter as the study progressed, so there was also a sense of self-efficacy at work here.

Does this mean that the exercise didn’t matter? Not at all! The emotional benefits of exercise have been documented in previous studies. If you consider the mind-body as a single system, as your physical fitness improves, your mental health will generally follow.

If you’d like to see the original article, it is available free online:
Malin Henriksson, Alexander Wall, Jenny Nyberg, Martin Adiels, Karin Lundin, Ylva Bergh, Robert Eggertsen, Louise Danielsson, H. Georg Kuhn, Maria Westerlund, N. David Åberg, Margda Waern, Maria Åberg. Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trialJournal of Affective Disorders, 2022; 297: 26 DOI: 10.1016/j.jad.2021.10.006

For a reader-friendly version, see the write-up in Science Daily:
University of Gothenburg. “Anxiety effectively treated with exercise.” ScienceDaily. ScienceDaily, 9 November 2021. www.sciencedaily.com/releases/2021/11/211109095348.htm

Perspective: The Broom that Sweeps the Mind

Last week, I had a good reminder about the importance of maintaining perspective.

It had been a stressful few days at work. At the height of it I found myself in a problematic situation, trying to “fix” an issue that wasn’t my responsibility by sending a quick email. I would have done better to pause, but I was in “go-go-go” mode, driven by anxiety that the situation was causing.

Afterwards, I found myself obsessing about what had happened and how I had reacted. So even though I had initially felt that my email response was the best course of action, by evening I was convinced that it was the worst. This opened the door to allow in unrelated doubts about myself. That frustration carried into my nightly meditation, and ultimately, into fitful dreams.

In a few seconds, a perspective shift changes your entire view of things.

The next morning, I felt marginally better. But it wasn’t until I checked my text messages that my perspective shifted. I received photos of my father, leg in a cast, at the local hospital’s emergency room. Reason? Cracked tibia bone and deep vein thrombosis.

In an eyeblink, I forgot about what had happened with work. I needed to get more information about my father’s predicament.

As news of exactly what had happened filtered down to me (it was a much more controlled situation than I had initially understood it to be), I went into the office with a different mindset. The work stress that had been top-of-mind and in-my-face was now way over there in the back of the room.

FYI, my father is fine and the trip to the ER was actually a follow up from the previous day’s visit to his doctor where they discovered the fracture and the blood clot. The doc had encouraged the ER trip to get quicker access to an orthopedist. My dad is in good spirits and my mother (a former nurse) has been tasked with administering the clot-dissolving injections.

But the shift in perspective that morning reminded me so much of a similar shift several years ago: prior to my cancer diagnosis I had been experiencing a lot of anxiety at work…but once I learned that the lump in my breast was cancer, everything else fell away. It was as if the roar of work stress suddenly became muffled and all I heard was my beating heart, my health, the important stuff.

When I had cancer, the things that used to bother me, stopped. I knew then what was really important.

I distinctly remember that as I was going through my cancer treatments, in all the concern about what was happening in my body, I experienced the least amount of anxiety about anything going on at work that I’d ever had at that job. It felt like I could handle anything that they threw at me.

Perspective. That’s what I had as I sat in the infusion room. And that’s what I regained last week.

How curious that the shift in perspective was so simple to achieve. All I needed was to remember what was really and truly important and everything changed within a few seconds.

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“Simple” is not necessarily “easy”. We have so many things coming at us in the course of the day and we try to triage them as quickly as we can. It’s expected that we will make “little mistakes” and give more weight to the problem right in front of us–those things that are immediate. But with practice, we can realize that most of those are transient and the important stuff is what deserves our deepest attention and appreciation.

And even the “important stuff” needs to be swept out once in a while.

Don’t Overpink It

If you have been living under a rock or have pink color blindness, it probably hasn’t escaped your notice that October is Breast Cancer Awareness month.

I know I shouldn’t disparage the color pink (after all, my hair is currently pink), but there is a downside to all of this “pinking.” Actually there are two.

Awareness is important, but has the inundation of pink made the month lose it’s meaning?

First, after some point, there’s so much pink that it starts becoming meaningless. Whereas it used to be loads of fun for pre-adolescent boys to go around with “save the boobies” t-shirts in the name of cancer awareness, and then make a social media stink about it when their school sends them home to change, I’m not really seeing that kind of enthusiasm anymore. Kind of like when something that was cool and forbidden becomes legal…it loses its luster.

Which is not to say that breast-saving have gone out of style. A quick search of local events in my area does result in a number of fund-raising events. After all, we are still being diagnosed with breast cancer and in ever-greater numbers. But maybe it’s because of the pandemic, maybe it’s because of my current state of mind, I’m not hearing much about spreading the word of breast cancer prevention (not simply screenings) anymore.

But there’s another part of the pinkness that I’ve struggled with. And that’s the pink everything around this time of the year. I mean, if we want people to be aware, I guess they’re aware. But those of us who have lived the diagnosis may need to turn our awareness elsewhere.

That may sound ungrateful of me because all that awareness has translated into dollars for research, potentially at the expense of other cancers. And even though I will tout breast cancer awareness at this time of the year, it also stings.

I’ve lost friends to breast cancer. And I lost a year to breast cancer treatment, not to mention a good amount of my direction in life. Yes, I’m recalibrating, but no, things are not back to “normal”. Cancer still means people and things that are gone and will not return.

Consider taking your breast cancer friend out for coffee…with no pink in sight.

At times all this pink feels like loud cheerleaders shaking pink pom-poms in my face. And for many cancer patients and survivors, being constantly reminded that it’s BREAST CANCER AWARENESS MONTH can be overwhelming. We may need to ground ourselves in where we are right now, being present and grateful for each minute and away from all the pink noise.

So I agree that with 1 in 8 women being diagnosed with breast cancer at some point in their lives, and the mortality rate still unacceptably high, it’s definitely important to spread the word about risk factors and urge that women do the oh-so-critical self-exams and not forgo screenings.

But it’s also a great opportunity to reach out to a friend or relative who’s a patient or survivor and offer to take them out for coffee or a walk…and let them forget what month it is.

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.

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.

Surviving Another Ride in the Tube

During my last oncologist appointment, I was told it was time for a chest MRI.

The last time I had one of those, I was barely holding it together–it had been a couple of weeks since my breast cancer diagnosis an dI was in an emotionally fragile state.

But that was four and a half years ago. This time, I was fine. I thought.

In case you’re never experienced one, the bilateral chest MRI is not particularly comfy. You lie face-down, your breasts hang between two open slots beneath you and your arms are outstretched in a “superman” pose.

I was a bit taller than they expected…things didn’t completely fit.

And you hold that for a specified length of time. I seem to recall almost an hour last time in 2017, but this time it was only a half hour. Which is good, since I had a hard time getting comfortable–based on how the MRI bed was set up, they hadn’t expected me to be quite so tall.

And since I needed “contrast” in my MRI, I was hooked up to an IV for infusing gadolinium. But the veins on my right arm (which is the only one I’m supposed to use) have seen a lot of wear and tear. Yes, they bulge and look nice and juicy. But it’s a lie. Only after some false starts–the first vein the nurse tried was a bust–did we get the IV going.

The MRI machine looked shiny and competently high-tech. I got to listen to spa music through headphones, which is kind of funny, since it’s like being at a spa where they also bang pots and jackhammer while you’re getting your treatment. In case you’re not aware: MRIs are LOUD.

Ironically, there’s something quite positive about that: the percussive nature of the noise has an almost lulling effect–if you let it. This worked quite well with my strategy of meditating throughout the procedure. Breathing was not particularly comfortable because of pressure on my ribcage (again, due to my height and positioning on the bed), so I chose not to focus on it.

The dressing room was cute, but I couldn’t help feeling so alone in it.

Instead, there were many other bodily sensations that I could pay attention to. At times, I could “feel” the MRI in my hips and spine. I focused on the weight of my body on that bed and on releasing tension whereever I sensed it. Compared to the previous chest MRI, I felt a sense of grounding.

But there were little cracks in my composure. I took a picture of the cute little dressing room where I changed and left my clothing. It was lightly decorated with homey touches. At the same time, it looked so empty: my gown on one chair, my belongings on another. Briefly, I felt small and alone.

After unsuccessful attempts, the IV was connected, and I remembered the feeling of expecting that things were just gonna hurt.

After I got home I removed my bandages from the IV arm and looked at the crook of my elbow, and it reminded me of all the pokes that I’ve endured. All the discomfort that I learned to expect and not question if it was necessary, because it always was. And I fought back feelings of helplessness.

It’s not all bad. This time, I had a better grip on things. I wasn’t even thinking about the MRI the next morning when I went grocery shopping, until…

…I saw a call come through from my oncologist’s office. And suddenly my heart started racing. It was a pure knee-jerk reaction. The voice on the other end told me that the MRI looked normal and my oncologist would see me at my next scheduled appointment next year.

It took a bit for my heart to calm down. I hadn’t been worrying about the results, certainly hadn’t expected anything bad, but wow, when that phone rang, it was as if my brain yelled at me, “Time to PANIC!”

This ride in the tube had a happy ending. But there’s no mistaking all the anxiety bubbling under the surface. Try as I might, I am always going to associate these procedures with fear and possible death. Memories of what happened a few years ago are not going anywhere.

And that’s okay. Because even though my reactions to those memories may still be stressful, I can accept that this will be the case and not expect them to be otherwise. And that acceptance is one of the most valuable skills that I’ve learned.

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.

After My Last Oncologist Visit, I Fell Off A Cliff

I had an oncologist appointment last Thursday that marked four years of being done with chemo for breast cancer.

During my previous onc visit in February, I had been a mess: depressed, stressed and miserable with joint pain and a feeling that my endocrine therapy was taking away from me more than it was giving me. At that point, he let me stop the aromatase inhibitors.

Now, half a year later, I felt so different. My blood pressure was 118/83, much lower than the 130s and 140s systolic numbers I was hitting after stepping into the exam room on previous visits. I was peaceful and more hopeful.

We discussed all sorts of “survivor” things. The joint pain had mostly resolved itself and was no longer a hindrance to exercise, one of the things most important to me. My libido could have been higher and my short-term memory was often lacking, but he felt that could also be attributable to working and sleeping in the same room for the past year and a half, coupled with menopause.

Finally, my doctor noted that it was time for another chest MRI. Not the most comfortable of scans, but I’d done it once, I could do it again.

I would love a pet, even if it means having to clean fur out of my keyboard.

It was not until around noon of the next day that I suddenly plunged off a cliff. I was talking to my daughter and randomly mentioned my willingness to look after any pets she might have in the future when she’s living on her own, were she to travel for work, because where we lived now we weren’t allowed to have pets…

…and I was slammed by a massive wave of sadness and regret.

My thoughts zoomed back to my first chest MRI, stripped to the waist, lying on my belly, arms stretched over my head, frightened and painfully vulnerable. All my focus was on breast cancer and what other horrible realities the MRI would reveal. All I could think of was surviving my upcoming treatments.

That MRI meant that my life was on hold. There would be no progress in my career for the foreseeable future, and no chance of moving into a bigger place, one that would allow us to get a cat (note: I’m a dog person, but I would have been happy with a cat!). Animals have always been a part of my life, but our apartment rules prohibited them. I yearned for the chance to have a pet again. It seemed such a small thing to ask, but even that wasn’t available to us now.

That brief discussion with my daughter underscored a profound feeling of loss and despair. Cancer had robbed me of a lot of things in my life that others took for granted.

This was my view before I realized I didn’t have to sit there.

And as I sat there in the depths, I forgot that time does not stand still, things are always changing, nothing is permanent…and I have inside me everything I need to climb out.

Curiously enough, I had recently attended a talk on managing anxiety aimed at cancer patients and survivors. The counselor who presented the information was herself a breast cancer survivor and she told us a story of doing a follow-up chest MRI, which she found very stressful. Afterwards, she was asked by one of the cancer nurses what sorts of mental tools she had used while in the MRI tube to calm herself down. At that point, she realized that even though she taught these techniques to her patients on a daily basis, she had completely forgotten to use them herself!

I had been sitting in the darkness for a few minutes when I remembered her story. Most importantly, I remembered that I didn’t have to feel this way, that it served no practical purpose and that I wanted be happier. The only reason I felt like this was because these emotional plunges had been a habit of mine.

So I twisted a rope out of all those grounding techiques that I’ve posted about and pulled myself up.

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True, I still didn’t have a cat. But I was able to take a deep breath and realize that at least I had a future. And that future might contain a cat.

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.

I Still Don’t Recognize “Myself”

You know how you have a picture of yourself in your mind’s eye? The way you imagine you look?

For four years, that self didn’t mesh with reality.

I still saw the long-haired fitness freak who’d never had a surgery in her life and definitely no serious illness. The one who was remarkably healthy at 50…the one whose co-worker assumed was age 35.

This is a perfect illustration of how I felt post-diagnosis.

That reality changed in an instant. The unbelievable happened, the unexplicable knocked me off my feet. There was no transition time. I went from super-healthy and super-fit to being diagnosed with one of the most dangerous diseases in our experience.

As the saying goes, “If you don’t have your health, you don’t have anything.” My health was everything to me, and suddenly I felt as though I had nothing.

And in the cruelty that is cancer treatment, off went the hair. Now there was no mistaking that I was “sick”. So when I bumped into friends who hadn’t heard about my diagnosis and tried to explain what had happened, they all said the same thing: “I know.”

Every time I walked past a mirror, I would get a shock. And this went on. Through the months of chemo, through radiation, waiting for regrowth that seemed to take forever.

My oncologist told me to be patient, the hair would come back. It was different for everyone. But I was still scared. And acceptance was a new concept that I was not comfortable with.

Yes, I felt I bounced back the year after chemo – working out hard, with the most awesome new-growth hair that random people would stop and compliment. That year, I felt strong and full of promise. I dared to say that cancer MIGHT have been the best thing to happen to me…

But as time went on, reality moved in again and I realized that there really was no going back. And that “lift” that I had gotten after my hair started growing back and I was hitting the gym hard, well, I crashed again.

Picking up the pieces has been a process…

Endocrine therapy pushed me through menopause. My hair thinned. And most devastatingly, I lost two friends who had been diagnosed with breast cancer around the same time that I had been.

I couldn’t celebrate that. And I fought it for months and months.

Four years later, I’m comfortable with calling myself a cancer survivor. But you know what? I still get a little jolt when I walk past the mirror. It’s still not the “me” that I expect to see. After several years of endocrine therapy, I do not look like I used to. My body doesn’t feel like it used to.

So I stopped beating myself up about it. I need more rest time between workouts. I get tired earlier in the evening. Yeah, I forget things. A lot. So I write more notes and declare my intentions out loud (“I’m going to have to take the next exit…”) so I remember what I’m doing.

I still don’t recognize “myself” in the mirror, but that is a previous “self” who was the right “self” for that time. The current “self” is wiser and more gentle with her body and her spirit.

And I do recognize her.