My Top 4 Mindfulness Apps

This time of the year is stressful for me because it’s the anniversary of my breast cancer diagnosis. That means it’s time for the scans that determine whether I can continue to consider myself “cancer-free”. Scanxiety, anyone?

This week is going to be a doozie, since I have my diagnostic mammogram on Tuesday followed by a cardiologist appointment on Thursday, the latter of which has become, ironically, the major stressor as I try to determine whether I’m suffering from “cardiac anxiety” or an actual arrhythmia (one of the possible side effects of aromatase inhibitors). To top it off, I get my first COVID immunization Friday, which brings its own stressors since I’m a bit “side effects-shy” these days.

Given all this, it’s a good time to talk about what apps I use the most to help calm my anxious mind. I’ve written about quite of few of them in my “Mindfulness Apps I Love” series, but here are the one I keep coming back to (all have generous free offerings; both Calm and Insight Timer have had major upgrades since I originally posted about them):

The app I started my meditation practice with. I use it at least once a day, every day.

Calm
This was the first mindfulness app I downloaded and it’s the one I’ve used every.single.day since March 13, 2017. I find the voice behind the app, that of Tamara Leavitt, very soothing. Since I started with it, Calm has added a number of elements featuring voices of celebrities, music, movement, classes, sleep stories, background sounds and other features that I haven’t even used.

What I use most: The curated “Daily Calm” meditations are my do-to first thing in the morning or if I wake up in the middle of the night with troubling thoughts swirling in my head — Tamara’s voice gives me something to focus on and shoos out the scary negative self-talk.

Why I like it: Because all the material is created specifically for the app, I always know what I’m going to get. It’s predictably high quality using a consistent format, and for me, it works. Also, once the meditation is done, the background sound continues and provides a soundtrack for drifting back to sleep or continuing meditation on my own, if that’s what I need. Finally, since this one was my first app and I ended up investing in a lifetime membership, I get access to everything it has to offer. If you’re not ready for such a loyal commitment to this app, you might not have quite as much to choose from.

By far the largest selection of meditations, classes, music and more that I’ve ever seen anywhere. You’ll need time to look through the offerings, but relax, there’s a search function. 🙂

Insight Timer
This app offers a large collection of many meditations, music, classes and whatnot by a huge array of teachers. You need to search around because you don’t always know what you’re going to get, but if it’s out there, it’s in this app. I’ve played around with meditations that I might not otherwise just because they were available to try out. And now new, there are live events that include meditations, concerts, even yoga classes that you can join to help maintain a sense of community–so important at a time when so many in-person venues are closed.

What I use the most: I’ve settled on a handful of teachers with voices and styles that I prefer. Often, I use this app at the end of the day, when I’m trying to clear my head and settle into sleep, but it’s also great for any time when I want some guidance for settling down and am looking for variety.

Why I like it: OMG, the selection! Not only is there just about every type of meditation available (secular, sacred, shamanic and so much more–and now the app allows you to filter out the ones that make you, shall we say, “uncomfortable”), but there is a vast array of languages in which to listen. I speak a specific European language from a small Baltic nation, and yep, Insight Timer has a meditation in it. This is really worth looking into and most of everything is available for free–but donations in support of the app and teachers are very welcome.

Unwind has lulled me back to sleep after nighttime wakings with too much swirling in my head. It’s prevented me from throwing myself headlong into anxiety, as I’m reminded that breathwork is a tool to put the breaks on runaway fear.

Unwind
This is an app that I recently reviewed here, and as I’ve gotten more into breathwork and vagus nerve relaxation, it has become invaluable to me. The combination of ambiances that you can select from paired with a gentle guiding voices that cues breath inhales, exhales and holds has made this perfect when I don’t want a guided meditation but I do want something to focus on.

What I use the most: Lately I’ve been opting for the “box breathing” pattern (inhale, hold, exhale, hold). It is perfect for calming my mind without straining my breath. I pair that with the “River Under Bridge” background ambiance that is a nice combo of gentle bird sounds with soothing running water.

Why I like it: Unwind has gotten me out of some anxious moments, specifically too-early wakings brought on by a racing heart. Instead of throwing in the towel and deciding that I’m just going to have to start my day at 4:27am, I’ve been able to lull myself back to sleep; again, the spoken breath cues provide guidance but are unobtrusive enough to allow drowsiness to set it. Additionally, Unwind is ideal for those times of my day that I need to eke out some head space and take a break from work pressure. Even a few minutes is enough to get my breath under control.

MyNoise helps me put distance between myself and my fears. It generates the mental space that enables me to step back and observe what’s going on without being pulled into it. And of course, the wide selection of sounds will mask just about anything.

MyNoise
I posted about this app in late January. It’s the most recent one that I added, but it is amazing! MyNoise consists of sound generators that you can manipulate to your liking, to create unique and changing background sounds for literally just about any mood or need that you can imagine! In addition to the app, there is a website (mynoise.net) that provides similar generators. Both the app and the site offer so much, but when I’m working on my computer, I’ll usually listen through the website since my eyes do better with the large screen.

What I use the most: I tend to prefer nature sounds with running water or else drones and more meditative music. My daughter, who is also a MyNoise afficionado uses the sound of medieval scribes to create an atmosphere conducive to doing college work remotely.

Why I like it: S P A C E. MyNoise creates space by masking unwanted ambient noises (busy street, noisy neighbors, etc.) and thereby provides breathing room and headspace. I have used this for mental breaks throughout the day, or for times when I feeled overwhelmed and need help staying present. There are no discernable loops in the sounds and because each sound generator is made up of different elements that can be manipulated by sliders, you literally can create a totally custom sound environment. It has to be experienced to be believed and it’s well worth experimenting with.

So, these are the four apps that I’ll be working with a lot this week as I make my way through scans, tests and immunizations. Each app has their own little something to contribute to maintaining my peace and I appreciate the portability of having such effective soothers in my hand, on my phone.

The Case for Chilling Out: Stress and Cancer Recurrence

In case you’re wondering why there’s all this mindfulness stuff on a cancer blog, here’s a reason: a recently published article in Science – Translational Medicine (Perego et al., 2020) provides laboratory evidence for the benefits of reducing stress levels for cancer survivors. It has to do with the effects of stress hormones on cancer recurrence.

In this study researchers looked at the cancer cells that are sometimes pushed into dormancy by treatments like chemotherapy. Cancer recurrence may be a result of such cells being activated again at some point in the future.

Findings in the lab may explain what’s going on in the human body–and ultimately lead to treatments that prevent cancer recurrence.

Perego and colleagues were able to recreate such dormant cancer cells in the lab, then found that they could awaken them again using neutrophils, a type of white blood cell that, under certain circumstances, can be harnessed by tumor cells to aid in their proliferation.

Those “certain circumstances” turn out to involve stress hormones. The researchers found that stress hormone + neutrophils = woken cancer cells. The process is a cascade of events: the stress hormones caused the neutrophils to produce S100 proteins, which in turn created lipids, and it was those lipids that caused hibernating cancer cells to stretch and rub the sleep out of their eyes.

Keep in mind that these studies were conducted in petri dishes (for “proof of concept”) and then in mice, which does not equate to eliciting the same response in humans. In fact, the connection between stress and cancer is still inconclusive in human studies, partly because in the past researchers have noted that some of the coping mechanisms that humans use to deal with stress (smoking, drinking, overeating, etc.) may be the more important culprits that lead to cancer.

Learning how to keep stress under control may be one of the most important things that cancer survivors can do to help prevent canver recurrence.

Nonetheless, Perego and colleagues were able to show that stress and neutrophils may form a path by which dormant cancer cells awaken in humans, leading to cancer recurrence, and this opens the door to more directed future research. Note, this is certainly not the only way that cancer can recur, but it provides an opportunity to develop drugs that can break the cascade and thereby prevent recurrence in some cancer survivors.

To be clear, this doesn’t mean that if a cancer survivor is stressed out their cancer will definitely come back, because there are a number of intermediate steps that need to take place within that cascade, but this is still a good reason to practice stress-reduction techniques. It might help you remain cancer-free.

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For a reader-friendly version of this study, go to the National Cancer Institute’s Cancer Currents Blog’s article, “Study Suggests a Link between Stress and Cancer Coming Back”.

If you have access to a university or hospital library, you can look up the original research article using the following PubMed citation (links to abstracts below; once the free full-text PMC version is available, I will link to it here):

Perego M, Tyurin VA, Tyurina YY, Yellets J, Nacarelli T, Lin C, Nefedova Y, Kossenkov A, Liu Q, Sreedhar S, Pass H, Roth J, Vogl T, Feldser D, Zhang R, Kagan VE, Gabrilovich DI. Reactivation of dormant tumor cells by modified lipids derived from stress-activated neutrophils. Sci Transl Med. 2020 Dec 2;12(572):eabb5817. doi: 10.1126/scitranslmed.abb5817. PMID: 33268511.

Three Pillars of Fitness: Consistency, Progression and Balance

Although this is a blog about cancer and mindfulness, I hardly think there is any lifestyle habit as effective as exercise at helping survive cancer. And what better time to discuss this than the start of a hopeful new year?

I’ve been certified as a personal trainer by the American College of Sports Medicine (ACSM) for well over a decade, and although I haven’t actively taken on clients, I’ve had enough time to develop my own fitness philosophy. I must stress, this is a conceptual post and not designed to guide you to specific exercises (although I mention some modalities as examples). However, if you’ve had trouble getting your head around how to maintain an active lifestyle, these ideas may help.

In my experience, there are three critical aspects to a successful exercise program: (1) consistency, (2) progression and (3) balance.

CONSISTENCY

This is the most important concept of my three and worth spending the most time on.

Consistency is the concept that seems to be most difficult for people, and it’s usually the “make-or-break” aspect of fitness. It’s quite simple to get motivated to start a new program, whether it be signing up for classes, planning out home workouts or simply deciding to go for a brisk walk every day.

The hard part is sticking with it. But I can promise you, that’s where the magic is. Be realistic about how much time you have to devote on a daily basis and what your exercise will consist of. This should not be something far out of your realm of experience or else it will be too difficult to maintain. Make it familiar.

When starting out, pick something you enjoy doing and it’ll be easier to keep doing it!

For example, if you do not already have a consistent history with a piece of exercise equipment (say, treadmill), do not purchase one under the assumption that the high price tag will surely motivate you to use it. It will not. The greatest workout you’ll get with it is carrying it to the basement or attic after you can no longer stand the guilt of watching it gather dust.

If you can’t maintain your workouts, you will have to go through the “beginner” phase every time you summon the wherewithal to restart again.

That also means going through “beginner soreness”. Honestly, there’s little pleasure in a Groundhog Day-like experience of not being able to get past the little aches and pains you might feel after getting your body into motion again. Don’t do this to yourself.

How to avoid it? Look at exercise as a lifelong habit, not something you do just to “get in shape” for a specific event like a wedding or reunion. Take smaller bites of exercise, something very doable that you won’t dread, especially if you have negative associations with workouts. Set goals like “train 5 days a week” and plan them out, not “lose 15 pounds” or even worse “look better” (what’s that?). It’s more motivating being able to tick off a specific, finite goal than never reaching one that’s vague, arbitrary and even judgemental.

And DO consider it “training”. You are training for living the rest of your life with more ease, maintaining your flexibility, balance, strength and endurance just that much longer. As in the tale of the tortoise and the hare, starting something that seems “not vigorous enough” but that you can see yourself doing, say, every day, in a year will put you miles ahead of someone who started an ambitious and complicated exercise program and burned out in a matter of weeks.

The fitness industry is banking on the fact that people will start exercising and then give up, only to start again later. And eventually give up again.

Look at it this way: the trillion-dollar exercise industry is betting on you giving up, and so it always comes up with a new shiny object to tempt you with. Often the program is unsustainable and the promised results are unrealistic. You don’t need that. You need consistency.

Again, decide what you can do and do it regularly. Realize there will be days when it won’t be possible to get it done. That’s okay – no guilt, no shame. But then get right back to it as soon as you can. Think of every workout as something positive and precious that provides you with health benefits that no one else will be able to take away. Each day you exercise is one more step towards establishing a habit that will lead to a lifetime of fitness.

Got your exercise in? MARK IT OFF!

IMPORTANT: Put up a high-visibility calendar where you can mark off your workouts and easily see how consistent you are.

But what if it gets TOO easy? That’s when the next pillar comes in…

PROGRESSION

Once you’ve established an exercise habit, your body will eventually adapt to what you’re doing. This is a very good thing. It also means that it’s time to change things up a bit, always giving yourself permission to dial back down to what you’d been doing previously if you have a harder time getting going on any given day.

Is your walking route getting too easy? Make a detour to a set of stairs and get your heart rate up!

The trick is to maintain consistency while also challenging yourself. For example, if you were doing a walking program, incorporate bodyweight exercises (squats, modified push-ups) that you can do along the way. Climb more hills. Pick up the pace.

If you want to get a PhD, you don’t keep taking freshman-level classes. Challenge is where growth happens. We get an unmistakable sense of satisfaction putting in the work and seeing results.

This is also where your self-confidence blossoms. And that’s exactly the bouyed spirit that keeps you going.

Don’t ramp everything up at once. Add a little at a time, but definitely make it count. Be realistic about whether or not you’re challenging yourself: if you need to push it even more and can do so safely, go for it. If you honestly try but can’t do as much as you expected, halve the amount and try again. Don’t beat yourself up. You will get there. But don’t short-change yourself either.

Keep writing it down! When you’re ramping up your fitness program it’s important to keep track of your progress.

Most importantly, unlike high school PhysEd class, you’re in charge. That also means you’re responsible for your own progress. Some workouts will be better than others, but always remember, doing anything is STILL better than binge-watching Netflix with a bowl of chips on your lap. Congratulate yourself for making the decision to exercise!

Hey, why not watch Netflix while marching in place? It still counts so write it down!

So let’s assume that you’re being consistent and gradually increasing the duration/intensity of your workout. That’s perfect, but there’s one more pillar to consider…

BALANCE

In this case, I don’t mean balance as in being able to hold tree pose throughout your entire lunchbreak. I mean are your workouts well-rounded? I’ve seen runners do little else but run. If this is you, incorporate some variety into your life. Your running will improve if you are also training for strength and flexibility.

Hey, your other shoulder needs massaging too!

Here’s a simple analogy for balancing out your workouts: imagine getting a massage regularly, but on only the left side of your body. That side will feel great, but you’re missing something. Your right side needs some love too. Eventually that imbalance will affect you negatively.

Exercise programs are best when they are a melange of endurance, conditioning, strength work and staying limber. It is extremely tempting, once you become adept at an exercise modality, to keep at it at the exclusion of everything else. After all, you’re an expert in it. But you’re also opening yourself up to injury and that’s something no one needs.

Treat your body to something new just to keep things interesting.

Take the time to explore different modalities. Often a type of exercise (say, yoga) can cover a number of bases, but you will still need to supplement with other exercises to stay truly well-rounded. Even strength training (which I consider critically important, btw) can have a cardio effect, but much will depend on how your workout is structured.

Do some research but don’t over think this. Just make sure that you are supporting all your body’s needs. Taking the runner’s example again, strength training will help you maintain muscle mass that you might lose from too much running, and it, along with flexibility and mobility work, will help prevent overuse injuries.

This doesn’t mean that you have to significantly increase the number of workouts you do, just that you have to be creative in what you add to your exercise session. The idea is to incorporate what else your body needs to keep it humming optimally. And then, write it down.

BOTTOM LINE

Bottom line when you’re just starting out? Move. Even if you don’t really know what exercise you “should” do, just find a way to move. Dance. Wave your arms over your head. Break up sedentary times as much as possible. If you sit for an hour, stand up and walk in place for three minutes, swinging your arms. Don’t be afraid to work up a sweat.

Then keep doing it.

When you establsh one healthy habit, it’s easier to incorporate others to support it.

Above all, make it pleasant, so that you look forward to exercise as a break from those things in our environment that keep us sedentary. The human body was meant to move. That is its natural state. Give it the opportunity to do what it’s supposed to do, then let it recouperate and nourish it with healthy food. The idea is to start now and keep going for the rest of your life.

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Being an avid exerciser enable me to recover from cancer treatment much more quickly. Up until my last couple of infusions, I was rowing and lifting weights within a week after each chemo (mine were spaced three weeks apart). In an out-of-control situation like cancer, exercise was one constant that made me feel like I still had a grip something, and that made the whole experience better.

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.

I Am An Imperfect Meditator

I meditate. It is a daily habit that I engage in with the best intentions, but I am a victim of my wandering mind. Some days are better than others, most days I struggle with distractions.

Often, I can be halfway through a sit before I realize that I’ve been clenching my jaw or tensing my brow or gripping some other part of my body, thinking I’ve been relaxed but I’ve been kidding myself.

There are times that I’ve managed to stay with my breath, and then start getting excited that I’ve stayed with it that long, and then start imagining how I might look, staying with my breath…and of course, then I’m no longer meditating.

Yep. Welcome to the noise in my noggin’.

So it goes, day in, day out. Everyday, once or twice a day, or maybe even more. Some days feel like a complete waste, like I’ve got a freeway running through my head and have no idea what I’m doing.

But once in a while, I get a few moments of golden light. They may just flicker in and out, but when I look back at those moments I know everything flowed.

And those mindful sessions make all the other ones worth the effort. Every time I pause before reacting. Each time I recognize my body’s physiological response to a stressor. When I remember that I don’t have to respond with anxious energy. That I get to chose what happens inside my head. That I can just say, “Sh-h-h-h.”

That I can stand back and observe the storm without getting sucked into the whirlwind.

I meditate and often don’t do it well. But I still meditate. As of this posting, 1,380 days in a row, originating with the most frantic breaths shortly after my cancer diagnosis. Even through chemo, when I thought I wouldn’t make it through the night. Sloppy meditation sessions that seemed to be going nowhere.

Change doesn’t require force, it requires consistency.

Those imperfect meditation sessions have changed over time, imperceptable on a daily basis. Perhaps they have worn away a few rough edges the way constant drops of water oh-so-gradually wear away a stone. And just as an indentation forms where the drops hit, so meditation has molded a little basin for me, a bit of extra space in my mind that provides just that much more breathing room.

I am still at the very start of my mindfulness journey, so imperfect and stumbling. But even with the little that I have achieved, I am light-years ahead of who I was before I started, wide-eyed with fear and not knowing how to stop the rush of emotions.

It was terrifying then because I didn’t realize what was happening. Now I know, and that makes all the difference.

“The Gun Show”: Assessing Biceps Muscle Loss Due To Endocrine Therapy [PHOTOS]

In my last post, I whined about the repercussions of taking aromatase inhibitors (in my case, letrozole) as a way to diminish the amount of estrogen in my body, for the purpose of reducing the risk of breast cancer recurrence.

While I also mentioned letrozole’s effects on my exercise habits, in this post I wanted to drill down on one aspect in particular: muscle loss.

Before I go further, I need to add a disclaimer. Since the time the first photo was taken (the morning before my first chemo infusion), three and a half years passed and I went through menopause. Notably, the menopause was pharmaceutically-driven, starting with tamoxifen and then, after my hormone levels were low enough, continuing with letrozole. However, my body now is dealing with the same aging effects as someone who had transitioned naturally.

Except that my transition came before its time.

The below photo is from April 27, 2017, before I headed to the infusion center for my first dose of chemo. I had been training as normally as I could, under the conditions of lumpectomy and port placement that I wrote about here, and finding work-arounds for exercises that I’d been told not to do.

This is my 51-year-old biceps muscle, before I started the pharmaceutical portion of my breast cancer treatment.

While I lost some size and strength throughout my chemo infusions (here are all the photos), I was able to bounce back and had a particularly strong 2018 (sorry, don’t have good photos of that). But as the endocrine therapy with tamoxifen continued in 2019, to be replaced by letrozole in 2020, I could feel the effects of low estrogen.

On December 11, 2020, I struck the same pose again for sake of comparison.

Is something missing? This is my 54-year-old biceps muscle, struggling to keep up. Note: I am still working out as hard as I can!

As far as muscle appearance is concerned, I have experienced a slow downhill slide. My shoulder is not as peak-y, the biceps itself has decreased in size and I even find it more difficult to hold this muscular contraction. In addition, there’s more looseness in my skin, particularly at the back of my arm, which in part may be due to loss of collagen, also affected by estrogen levels (nice dermatological review by Shah & Maibach, 2001, Am J Clin Dermatol).

I’m busting my butt trying to increase the amount that I’m lifting, but I’m not making progress. Not surprisingly, the decrease in estrogen plays a role in this. As stated by Chidi-Ogbolu & Baar (2019, Front Physiol), “estrogen improves muscle mass and strength, and increases the collagen content of connective tissues”.

It makes sense then that lack of estrogen is going to be detrimental to maintaining muscle. To that point, Kitajima & Ono (2016, J Endocrinol), working with animal models, have found that “estrogen insufficiency leads to muscle atrophy and decreased muscle strength of female mice.”

Not just mice, obviously.

This information comes as no surprise to any woman who’s gone through menopause, I’m sure. But the experience of being slammed through menopause instead of having the opportunity to transition more gradually is yet another frustrating way that having cancer pulls the rug out from under you and reminds you that you are not in control of your life.

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Slowly, yoga is becoming more important in my life and my view of fitness is changing. Good thing too, since I can’t keep beating myself up like this.

Understanding Clinical Research

If you’ve had cancer, you know that the information presented to you following your diagnosis is like a crash course in medicine.

All of a sudden you’re hit with explanations of complex bodily processes, unpronounceable medicine names, and a deluge of statistics. You need to digest all of that and agree to a specific treatment plan, of which there may be several for your type of cancer. It can be overwhelming. But then again, what about cancer isn’t?

Okay, but what does it all mean?

Making the “right” decision for you can be difficult. Many of us gravitate to the Internet for information, but that can be a minefield of questionable value. With some luck, we eventually get to PubMed, which is Ground Zero for medical information. PubMed is the National Institutes of Health’s (NIH) database of published research on a variety of topics. These articles focus on biomedical fields, but the range is quite broad.

There, you can find the background information for the treatment decisions that your oncologist has made about your specific situation.

I would venture that bringing a relevant scientific article to your oncological appointment beats mentioning an ad for a new medicine where the announcer says, “ask your doctor if [insert med name here] is right for you”. But of course the commercial is easier to understand, while the research article is written in “science-ese”.

So, if there’s something that can serve as a true ally as you navigate through your cancer experience, it’s being science-literate. That doesn’t mean you need a PhD in some medical research field. But it does mean understanding how researchers set up experiments, what they’re actually studying, and whether those results are valid for your situation. And then being able to search through clinical studies and see whether they can inform your decisions on cancer treatments.

For digging deeper into the specifics surrounding clinical research, I highly recommend Coursera’s free class, “Understanding Medical Research: Your Facebook Friend Is Wrong.” I use PubMed at work and have studied research design in Psychology, but I realized that I needed a crash course in evaluating clinical studies if I wanted to use scientific literature to make informed decisions about my health. “Understanding Medical Research” is an excellent survey of the types of studies out there, basic research design, terminology, relevant statistics and how to judge whether the study is useful for your personal situation, not to mention warning flags to watch out for.

Dr. F. Perry Wilson teaches the Coursera class, “Understanding Medical Research: Your Facebook Friend Is Wrong.”

The course is free if you don’t need the Coursera certificate. And the instructor, nephrologist F. Perry Wilson, MD from the Yale School of Medicine, is entertaining and occasionally silly, making what could be a dry subject much more palatable.

This might not be the first online class that you’ll want to tackle right after your cancer diagnosis. For that, I would highly recommend seeking out a mindfulness meditation class. But after you’ve gotten relaxation skills under your belt, learning about how to access medical literature and decipher the results may be one of the most important things you can do for yourself.

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If you’re not ready to commit to a course on understanding medical research, below are two informational links that can still get you on your way to figuring out what all the research means:

The National Cancer Institute (NCI) has a blog that explains findings from the latest cancer studies in lay terms, called “Cancer Currents”. The sidebar on the right allows you to zero in on more specific topics. This is the most science-based information that you can get on cancer, keeping in mind that studies can only speak to what they have specifically been designed to research.

For some general information on clinical studies, NIH’s webpage on “Understanding Clinical Studies” is a good place to start. This is a one-page easy read with a infographic that explains basic facts about clinical studies.

Inviting Gratitude, Gently

Since this week is the Thanksgiving holiday in the US, it’s a good time to revisit the practice of gratitude. I wrote some time back about my nightly practice of writing down three things for which I was grateful. It was a lovely way to close the day on a positive note, as I would always be able to jot something down, even if my day was difficult.

Nightly gratitude journaling started feeling forced, certainly not the point of the practice.

However, after a number of weeks of this, I found it harder to be consistent. I would skip days, and often on the days that I could find something to write in my journal, the process would feel forced. The more I had to work to pull out little things to be grateful for, the less meaningful they became. Eventually, and regrettably, I stopped the nightly practice altogether.

Apparently, this is to be expected. Psychologist Sonja Lyubomirsky and colleagues from UC Riverside found that journaling once a week was more effective for boosting happiness than doing so more frequently. I can see why this would be. Everyone has stressful days that can wring any semblance of happiness out of us. Yes, while I found something to be grateful for any given day, if the overwhelming feeling was that of negativity then I was simply going through the motions of trying to find something–ANYthing–to write down. For me, this waters down the effectiveness of the exercise.

But writing on a weekly (or less) basis allows me to focus on the most powerful feelings of gratitude, and those have a stronger uplifting effect on me. They last longer and evoke a joy that daily journaling couldn’t.

In my life, there have been times that have felt very dark and heavy. In the moment, I have not always been able to find anything positive in them. Take, for example, cancer. Those weeks around my diagnosis were literally the most terrifying of my life, because I felt that this situation could actually cost me my life.

Quite frankly, if someone had told me then that I should stop and think of all the things I was grateful for, I might have told them to go to hell. The intensity of what was taking place right then–the shock and disbelief, the despair, the sheer fear–was too great to let in any light. For someone to have suggested that I should essentially “look on the bright side” would have felt like they were dismissing the reality of what is cancer.

For me, the process of letting gratitude come to me was far more effective than trying to snatch it out of darkness.

But as I passed through those worst weeks, I noticed things that bobbed up to the surface that I could be grateful for, so much so that at times I was overwhelmed with gratitude for how events had unfolded compared to how things could have been. I still had cancer and my life was still upended, but I felt a sense of grace about it all.

So if were to give one piece of humble advice to someone going through desperate times, it would be to remain open to the possibility that no matter how dark things may seem right now, when you finally have a chance to take a breath, you may see that glimmers of hopeful light have been shining through all along.

Sleep Peacefully, Sweet Aira

“[A pet is] a little tuft of consciousness that circles around a person like a moon around a planet, and completes their energy field making them more whole.”

Dr. Rachel Naomi Remen quoting a spiritual teacher, as related by Dr. Nancy Novak on the Nancy’s List email newsletter, November 1, 2020.

There are few reminders of impermanence as poignant as life transitions. I experienced this over the weekend as we said goodbye to our beautiful Siberian husky, Aira. I knew the time was coming and that it was right to let her go, just a month shy of her 15th birthday.

Retirement: living the good life in her “golden years”, in her own room. Lots of naps and loads of love.

Aira’s transition was gentle. My mother held and stroked her as she lay on her favorite rug in her bedroom in my parents house. She fell asleep quietly with the first injection, and after the I.V. drug was administered, passed into peace, surrounded by the people she knew and loved in familiar surroundings.

She now lies beneath the window outside her room, one of her favorite places in the yard to sit during the winter, as it was almost guaranteed to have a snow mound. She loved that. As the days became warmer, that mound was one of the last to melt.

In her younger days, bright with husky energy.

I remember the silkiness of the fur on the backs of her ears. And the unbridled joy she exhibited when she would get loose and start tearing around the neighborhood. And how she would roll around in freshly fallen snow in ecstasy. And how wonderful she smelled after rooting around in a rosemary bush. And how we would find a dog treat hidden in a shoe, under a pillow or anywhere else she thought was a safe spot that she could return to later for a snack.

Everything changes. Aira matured and calmed down. She followed us from Chicago to California, then due to stifling housing constraints in the Golden State, was welcomed by my parents in Connecticut, where she got a beautiful yard, lots of snow and unbelievable amounts of attention. Years after their three kids had left, my parents and Aira formed their own little family unit and went almost everywhere together.

My father’s health faltered and Aira, too, started showing her age. The last year brought on the most striking changes. Aira sprouted a fast-growing mast cell tumor on her shoulder. By the time it was removed, the mass weighed almost five pounds, and her prognosis was guarded. That was in April of this year.

Some weeks ago, my mother noticed a hard spot in Aira’s belly. As with the previous tumor, this one grew lightning fast. And unlike the tumor on her shoulder, this one was among her organs and taking a toll on her. This one was not coming out.

I would lie away at night, wondering how this would end. Had I known how blissfully she would transition out of this world, my heart would not have felt so heavy.

Newly arrived at my parents home in New England, looking forward to the cooler air and, after years of California warmth, SNOW.

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I am Roman Catholic. When I was young, I remember a humble missionary priest speaking of how anyone could baptize someone with the sign of the cross and holy water. So, logically, I pilfered some holy water that my grandmother kept on a shelf and baptized our dog at the time, a good-natured chihuahua named Rudis.

Several decades later, when Aira was part of our family, I was already an adult (so I have no excuses), and as I was holding a small vial of holy water brought back from mass, Aira came to sniff at it. I thought, “Why not?” and baptized her.

I’m sure that I’ll be punished for this brazen transgression. And you know what? That’s okay. I hope that I’m banished to the place where animals go after they die, because I’d rather give up my spot in Heaven to spend eternity with my dogs.

There Goes Another Cancer Milestone…Big Deal

On October 23, 2017, I finished radiation therapy for my stage 1, triple-positive breast cancer. That was three years ago. At that point, I imagined myself being through all the “tough stuff”. I’d already had surgery that March, spent the summer enduring chemo infusions, and then six weeks of radiation in autumn.

October 23rd seemed like a “marker” day. I rang the gong in the radiology waiting room, with all the staff present and smiling. It was a day that I knew I’d remember.

Except that it didn’t end up being a very important milestone. At that point, I didn’t fully realize that the treatment doesn’t really end. I can only say that it’s been three years since I finished chemo and radiation. But the truth is that a few weeks after that I started tamoxifen (surprise!), which came with its own worries. And I still had more than half of my infusions of Herceptin (trastuzumab, a monoclonal antibody) left, which stretched into April of 2018.

I guess next April, I’ll mark THAT as another milestone.

This coming December I can mark a full year of taking letrozole (aromatase inhibitor), which came after two years on tamoxifen. But I’m still supposed to be on that stuff for “a few more” years – it’s funny that my oncologist has not been specific about that. And I’m not very interested in asking, unusual for me.

I really thought I’d have said “goodbye” to all things cancer by now, but its spectre still seems to follow me around.

What once seemed like a very clear treatment plan, a definite path through the cancer jungle, now seems fuzzy and gray. In one of my first posts here, I talked about being able to put everything behind me, with the more time that passed after “finishing” chemo and radiation. Who was I kidding?

When mammogram time comes up, there’s that familiar rush of anxiety, knowing that I’ll be sitting in that comfy robe in the quiet waiting room, pretending to enjoy a cup of tea, but my tummy will be floating and I’ll try to not to think of much. That’s the work of cancer.

When I wake up in the middle of the night with my hand aching and fingers painfully stiff, medication side effects that are deemed, by the medical community, to be “worth it”. That’s the work of cancer.

When I wonder whether my 18-year-old daughter should be doing breast self-exams now. And whether she’s be hurt by whatever “mistake” my body made in not cleaning up some tumorigenic genetic defect. That’s the work of cancer.

So it makes all those “milestones” a little less fun and exciting.

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But I have to be honest — I still note the time that’s passed by. For my breast cancer, the two-year mark is most important, followed by the five-year mark and then the 10-year one. Each year cancer-free makes me more cocky. But the truth is, one “bad” scan, and I’m back to square one: cancer patient. And then I’ll regret not having appreciated those milestones more.