Last week I had a 3-D mammogram. This scan marks a bit over five years since the diagnostic test that indicated I had a solid tumor on the outside of my left breast.
Heading into this appointment, I wasn’t particularly worried. Yes, I admit to having little heartbeat skips over “lumps” in my breast that aren’t really lumps: if you recall, I had felt something before my last oncologist visit; my doctor reassured me it was nothing.
I will never again hear the word “lump” and NOT think of cancer.
And because last August I’d had a chest MRI, a more sensitive scan than even a 3-D mammogram, it was HIGHLY unlikely that there was anything to be found in this mammogram.
But still, after the pictures were taken and the mammography technician left the room to consult with the radiologist, I got that all-too-familiar uneasy feeling.
WHY? I knew that the radiologist wouldn’t find anything. The technician practically said that out loud, since she was aware of my recent MRI.
But still.
I sat alone in the mammography room, breathing, looking at the clock on the wall and simply hovering. My attention was like a butterfly looking for a place to alight. I wasn’t holding my breath…but mentally, I had put the rest of my life on hold when the tech stepped out the door.
It took all of four minutes and the mammographer returned and gave me two thumbs up.
For four minutes, I had no plans for anything outside of the room I was in.
I breathed a sigh even though I had expected the good news. And while I wasn’t “freaking out” waiting for the response, it became apparent to me that I might always feel uneasy during that period of uncertainty.
I didn’t want that. I wanted to be completely unaffected, as if I had never had a bad experience and my heart was calm.
But hovering it was, because there are no guarantees. And as the gears of my life started turning once again, I remembered that there was no going back. All the negatives that have happened have happened and I can’t change that.
Eventually, years from now, my emotions may soften, but in the meantime, I’m just going to have to be okay with hovering for a few minutes.
Last week, I had a Pap smear. If you’re not familiar with what that is, you must be either male or blissfully young. In brief, it’s a test for cervical cancer, customarily done every 3-5 years.
I knew my results would come this week, along with other lab results. I was in a work meeting today when I noticed my phone was vibrating. It was my doctor’s office…and I was too late to answer the call.
Me: It’s probably nothing. Also me: OMG I NEED TO CALL NOW!
The doctor’s office didn’t leave a message.
And that’s when I officially tuned out the meeting. A flood of possibilities came rushing in. My boss needed to talk to me but I was trying to suppress the growing urge to call the doctor’s office immediately.
The urge won. I called and left a message and went back to work, but my head was elsewhere.
The fact that there had been no message was extremely unsettling, because it made sense that if there were really bad news, the office would want to speak with me directly instead of leaving a voicemail.
And my reaction shouldn’t come as a surprise, because having been hit with a cancer diagnosis before, I’ve become hypervigilant. Like it or not, my brain wants to prepare for the worst so that I don’t have that horrible fall from thinking that everything’s just peachy to slamming into a nightmare.
It doesn’t help that I’ve read sooo many stories of women talking about being completely blindsighted by frightening diagnoses, and all of them saying that they thought nothing of the missed call from the doctor since they knew they were perfectly healthy, blah blah blah.
Gotta be prepared, ya know?
Of course, I know better than this. And at least I was aware of the hypervigilance, aware of my body’s reactions and aware that I was blowing things out of proportion. But it’s that uncertainty that is so difficult to take. Even though I know my response, I know why it happens and I know that chances are everything is ok…I want that certainty.
As it turned out, the call had come from the nurse assistant to let me know that my blood work results had come in. This was a relief, although I admit I considered it a defeat that I couldn’t be mindful and breathe through it all.
Then again, as a cancer survivor, I need to cut myself some slack. Getting slammed with a devastating diagnosis once leads to understandable echoes, no matter what test results I’m waiting for.
For now, I’m calm. Of course, my actual Pap smear results aren’t in yet. Those should come tomorrow or the next day. The nurse assistant told me that they’ll probably be normal (OMG, how can anyone say that????) and they’ll be loaded onto the patient portal…unless they’re not normal. And then they won’t be.
Guess whose heart will be fluttering for the next few days?
Not mine, because I’ve got it together.
Kind of…
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To be fair, I didn’t totally freak out over this. But scanxiety over test results is getting a little old, honestly…
I had another oncologist appointment last week. This one was a milestone, since it officially marks five years since my breast cancer diagnosis.
Five years ago, I was told that with triple-positive breast cancer I had an 85% chance of survival…but there in the fine print was added “five-year survival”.
Delays in routine care due to the pandemic have resulted in more late-stage diagnoses.
With advances in treatment for HER2-receptor-positive tumors (HER2 being the third marker in “triple-positive”), that percentage has improving. But it’s still interesting to note that there’s a finite end to what reliable survival info your doctor can give you, since it’s hard to run longitudinal studies with a large group of participants.
In any case, my oncologist was happy to see me alive and kicking. With the pandemic, women voluntarily and/or involuntarily delayed preventative care, and as a result, there has been an increase in the percentage of women presenting with advanced-stage breast cancer (from UC San Diego Health). Given how far treatment itself has come, this is a distressing statistic because it means that we have effective treatments but patients are not getting them soon enough. So perhaps, for him, I was a five-year treatment success in the midst of all of this.
My oncologist’s concern now is less that my tumor will recur and more that whatever conditions were responsible for the first tumor might result in a brand new one. He still checked me over carefully. My bloodwork looked good with only a lower white blood cell count (“that may never recover,” he’s said in the past). I have no headaches, my bone pain has significantly decreased and other long term physical side effects from endocrine therapy have just about Sudisappeared.
Five years post-diagnosis I’m turning down another path, one that I would have never explored had it not been for what cancer made me face.
I’m still dealing with things like distractability issues, but that could also be due to menopause and the pandemic situation and maybe just the march of age in general. I’ve noted before that it’s hard to pull apart all the factors to identify a single culprit.
My oncologoist remarked that I looked like I was doing well, that I exuded a positive “aura”, and while I’m sure he didn’t mean that metaphysically, the truth is, I feel like I’m finally moving forward in my life again. This coming weekend I start a three-month yoga teacher training course that will move me down a new path for the future.
I still plan to keep posting weekly during this time. We’ll see how it goes!
“Supposing a tree fell down, Pooh, when we were underneath it?” “Supposing it didn’t,” said Pooh after careful thought. Piglet was comforted by this.
A. A. Milne
So, I felt a “lump” under my left nipple, what I refer to as my cancer-side. It wasn’t the same kind of lump that I remember from cancer but when I thought of how I’d describe it (mass, thickening, etc.) I came up with cancer-sounding descriptive words.
This “lump” was also way bigger than my tumor had been.
I think I feel “something” and –BAM!– my mind takes me to worst-case-scenario land.
Now you might think that I would reason with myself. I’d had an MRI in the late summer that showed nothing. A real lump that big would have shown up.
Again, it wasn’t a lump, it was a “lump”. But in the back of my mind, a film starting playing…
I was writing letters to my friends on how much I had appreciated their friendship. Practicing how to tell my kids that I wouldn’t be around to see them graduate from college. Posting my final thoughts here.
It sounds sooo melodramatic but my brain is like a motor boat left unattended with the engine running. And it’s just heading away on its own on a course that no one plotted.
Why do I “go there”?
There is a part of the brain called the Default Mode Network (DMN), which is the area that is more active when you’re at rest and otherwise not focusing on anything. There is a nice “plain-English” explanation here (from an accompanying article to meditation teacher Jon Kabat-Zinn’s Mindfulness course on Masterclass.com). It describes the role of the DMN in “self-reflection…social evaluations…memories…envisioning the future”. And it also notes that problems within the DMN can predipose people to a variety of cognitive issues, including anxiety.
Start my motor, cut me loose…and off I go.
This would explain a lot about my personal default mode.
The article goes on to describe how meditation can “keep the mind from wandering into stressful territory, like reliving traumatic events from the past or anxieties about the future.”
Well, it’s good that I’m meditating, then. But I’ve already put a lot of practice into panicking. I’m an expert hand-wringer. I have a lifetime of experience helped along by a series of anxiety-provoking events. Meditation is chipping away at my hypervigilance, but it’s a slow process.
The main thing that has changed, however, is that now I’m more aware when the motorboat putters away. It used to blindsight me and before I knew it, I was hit by a tidal wave of anxious sensations (tightening, gripping, nausea…). I didn’t realize that this habit of automatic thoughts was driving my anxiety.
Now, when I start down the road of “what if it is…”, I can stop and ask, “what if it isn’t”?
About five years ago around this time of the year, I had an uneasy feeling.
So, let me back up. The previous August 2016 I had felt a small lump in my left breast. It wasn’t all that different from another lump that I had gone to see my Nurse Practitioner about in late June 2016, and she had put my fears to rest.
Still, she noted that I hadn’t had a mammogram since 2013, so she wrote me an order for one so that I could keep on track with my screenings.
But I dragged my feet on the mammogram. And when the August lump appeared, I decided to wait until it disappeared–you know, like they always did–before setting up the appointment. Because going into a screening knowing that I had a lump seemed terrifying.
You can’t hide from your fears, but that didn’t stop me from trying.
It didn’t disappear. I kept feeling it, pressing it to see how squishy it was, did it move about, was it getting bigger. And all the time, wondering how long it would last. It was hanging around longer than I expected.
But I still waited because I was afraid. I didn’t want to go to the mammogram and have the technician look concerned. Maybe she’d call the doctor in and the doctor would look concerned. Maybe they’d suggest more tests.
I *knew* it was nothing because it had to be nothing, but I didn’t want to risk having the medical professionals think it was something because that would be terrifying to me when I really knew that it was nothing. I didn’t want to experience that fear needlessly. I was afraid of being afraid.
So I waited until around this time of the year in 2017, when, after talking with my mom, we both agreed that getting the lump checked out would relieve my building anxiety. I imagined a pleasant conversation with the Nurse Practitioner as she would say, “Don’t worry, it’s nothing.”
Except that’s not what my NP said. Her expression went from friendly-smiley to concern, and she told me that I needed to get that mammogram done as soon as possible. All that fear that I’d tried to avoid by not getting the screening suddenly hit me at once. As the NP left the examination room, she admonished me to not put the mammogram off.
The order that I got read, “Mammography and Diagnostic Screening”. The left breast on the picture on the sheet was circled. I think. To be honest, I don’t remember much more than that. To an outsider, I was just going to have a suspicious lump checked out. But inside me, there was a tornado of anxiety whipping around unchecked.
I know I know I know…but at that time, the fear of what might be overpowered common sense. So I waited.
I had waited six months simply to avoid fear. I was so afraid of the fear that I was willing to risk my life–even though I hadn’t see it that way. The overwhelming need to not experience fear trumped everything else because it was so horrible that I couldn’t seen past it. Nothing else mattered.
Believe it or not, I didn’t realize that I had been suffering from severe anxiety for a number of years. It was always bubbling right by the surface, occasionally boiling over, but never sufficiently dealt with. It had built up throughout my life through an unfortunate series of events and I had become worse and worse at shaking it, but the two years prior to my diagnosis brought some of the longest bouts of chronic anxiety and feelings of worthlessness.
And all that fear that I had, that reason for not getting the lump checked out, that fear that almost cost me my life? Cancer was what forced me to face it. The most feared disease that I could have imagined ironically put me on the path to finally dealing with one of the most crippling issues of my adult life.
No, I’m not going to say that I’m thankful for cancer. Because that would be ridiculous. But I can now step back and see the worth of fearful experiences and understand that sometimes it’s the horrible things that push you into the most meaningful personal growth.
A number of years ago, when my kids were still very small, we lived in an area with brutal winters. That meant sub-freezing temperatures for weeks at a time. Money was tight so we had to keep the thermostat in the 50s overnight and in the low 60s during the day. To make matters worse, our bedroom was in a part of the house that the radiator pipes wouldn’t warm properly, so it was always cold there at that time of the year.
Gratitude for a cup of tea and a quiet moment to write – that is enough.
And by “cold” I mean, the bedsheets would be literally frigid when it was time for bed. So much so, that my joints would ache and I’d be miserable until my body heat could warm them up.
This continued for a year or two until I found an electric mattress pad. The first night that I crawled under the sheets with the heat turned on, I thought I’d won the lottery.
There were so many negative parts to the years we lived there, but going to bed with warmed sheets overwhelmed me with gratitude for the simple pleasure of removing the pain of the cold.
The reason that I’m telling you this is that it’s so obvious to be grateful for the stark changes in our situation. It’s a no-brainer.
But there is no need to wait for something like that. There are simple things that we take for granted that it would be so easy to be grateful for.
Turn your attention to little pleasures and acknowledge their importance in your life. Take some time to sit and bring them to your awareness. Feel into how they lighten your existence. Maybe thinking about them makes you smile. Or maybe the fact that something is simply working properly can be enough to help us realize how fortunate we are to have it at all.
Whatever it is, open up and invite gratitude in.
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Maybe generating gratitude during bad times is exactly what we need.
Those of us who have recently gotten a cancer diagnosis may feel a touch bitter about this concept. Understandably, it may be easier to be grateful when you’re not dealing with a serious disease. And no one would blame you for having a hard time generating a mood of gratitude.
But perhaps that’s exactly when you should look for things that elicit a sense of gratefulness, no matter how small. It may be one of the most important things you can do to maintain a sense of well-being in a difficult time.
As 2022 approaches and we face the prospect of having another twelve months speed by us again, I’ve found it useful to sit down and take stock of where I was last January, what changed over the past year, and with what attitude I will enter into the next 12 months.
One thing that has caused a great deal of anxiety for me has been work, even with having one of the greatest bosses in the world and a flexible work situation.
My work situation is quite positive, but anxiety has left me with emotional claustrophobia.
Why? Because my job has also been associated with some of the most wrenching anxiety that I have ever experienced, including being diagnosed with cancer.
What’s resulted is that even in a supportive and stimulating environment (although not my passion, admittedly), I’ve felt trapped, like an animal trying to scratch my way out of my cage.
This past year, I came up with a tactic to at least partially relieve this feeling.
Now, I actually look forward to Mondays, because I’ve set up a beautiful association for the first day of the workweek with something very indulgent.
First, I work from home on Monday. This softens the dread that I’ve historically felt on Sunday nights, knowing that the weekend is over. The transition to the office is gentler.
Second, with some changes in my kids’ school schedules (one in college living at home and the other in high school), I start my workday an hour later. This has given the entire family reprieve from the stress of waking very early and starting the week sleep-deprived.
It also gives me to time to enjoy a cup or two of decaf in the morning.
Third, when the rest of the family leaves for school and work, I have 45 minutes before my own workday starts. I set up my rower for a 30-minute row, facing the tv/computer monitor in the living room…
Great exercise + fun videos = an amazing start to Monday!
…and put on a half-hour YouTube video of something I really enjoy that I might not have time to watch otherwise. For me now? It’s an episode of “BuzzFeed Unsolved–Supernatural”. Pure 100% indulgent entertainment.
Because it’s a timed row, when the 30 minutes are over, I stop. No pressure to hit a certain speed or distance. No matter what, it ends up being a decent workout because I enjoy the exercise.
That leaves 15 minutes before I start work. Chemo left me with short hair that allows for a five-minute shower.
By the time my workday begins, I am completely refreshed and the day’s workout is done. I feel like I’ve been given a huge treat–almost like I’m cheating, but I know I’m not. That 30 minutes of physical activity tied with watching a fun video re-sets my attitude and I’m ready to take on the week.
I love Mondays!
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Can you create your own positive association with the toughest day of the week or anything else that causes you grief?
Running late with this post as I’m furiously cleaning our apartment in advance of the Christmas holiday!
I noticed a few mornings ago that when I made a fist and then straightened the fingers of my right hand, the joints didn’t stick at all.
It took over 300 days…but I’m happy to celebrate the end of the side effects!
While this may seem like an odd thing to celebrate, it marked a milestone for me. This was the last side effect attributable to letrozole that I had been experiencing, and it was finally gone. Letrozole is an aromatase inhibitor that blocks production of estrogen and is used as endocrine therapy for breast cancer patients who have estrogen receptor-positive tumors. I’d been on it for about 14 months after switching to it from tamoxifen.
For reference, as of today, I am at Day 307 since stopping the medication, so it’s taken quite a while for this joint side effect to subside. Yes, there are other things still plaguing me, such as memory issues, low libido and difficulty maintaining muscle (even with strength training), but those are more difficult to separate out from the garden-variety effects of menopause.
The sticking fingers began in August 2020 (about 8 months after starting letrozole) and were getting progressively worse. By March 2021, when I called it quits with the endocrine therapy, a number of finger joints were sticking and painful, particularly in the morning.
At that point, I was having trouble getting up off the floor, as I was having issues with joints throughout my entire body. The medication was affecting various aspects of my life, making it difficult to exercise and, as I like to put it, lowering the quality of my existence. Following discussions with my oncologist, we both agreed that my risk of breast cancer recurrence was low enough to stop the meds.
It’s been quite a journey to get to the point where I am now.
Shaking this last side effect of letrozole reminded me how far on this cancer journey I’ve traveled. There have been so many ups and downs, friends made and friends lost to the disease, that it was easy to forget that nothing in life is permanent. Time passes and situations change, sometimes for better, sometimes for worse.
The concept of “CANCER” used to terrify me, and after I was diagnosed, I hit a low so deep I thought I’d never be able to crawl out of it.
Gradually, as my experience with the disease played itself out, I came to accept the uncertainty about the future. As the end of 2021 draws near, I inch closer to the 5-year survival mark. The fact that I can straighten my fingers in the morning without any pain or sticking is a perfect example of how while I cannot know what the future will bring, I can deal with the “now”. And this “now” is not so bad.
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Best wishes to everyone for a very Joyous Holiday Season and much promise for 2022!
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 trial. Journal 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
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.
Frantic Shanti 