Staying Present: Dual Focus Meditation

If you’re new to mindfulness meditation, you might have found it difficult to hold focus on your breath. But the reality is that you don’t need to be a beginner to struggle with this. There are some days that the mind refuses to be still and even a long-time meditator will find themselves carried away by thoughts.

In an effort to help keep my head here and now, I started paying attention to how it was that I lost focus. For me, it happens during the lull between breaths.

The breath remains the main focus.

What is that lull? Well, there’s a very short, almost imperceptible pause between my inhale and exhale. I’m okay during that time because I can focus on the sensations in my chest and belly. That’s not the pause that gives me problems.

It’s after the exhale that I experience a longer pause before the next breath begins, especially if my breaths are slower and deeper, because my body doesn’t require another breath right away. And that’s when I’m more likely to “see something shiny” and my mind wanders off.

But I found that by focusing on my hands during this pause, I could keep my random thoughts at bay.

If you’re having focus issues and would like to try this, all you need to do is consider your focus as cyclic. First, with the inhale and exhale, focus on the breath sensation–choose wherever you feel the air movement most distinctly, such as the rising & falling of your chest, the rushing of air in and out of your nostrils, or similar. It will be different from person to person.

Next, during the pause between your breaths, turn your focus to the sensations in your hands and fingers. There may be some tingling or throbbing, or perhaps nothing discernable. That’s okay. Just see if there’s anything there that you can feel.

Then, when your next inhale begins, pay attention to the breath again.

The main point of this exercise is to stay present during those times that the mind is very active.

It may sound like you’re jumping from one body part to another, but in reality the transition is very smooth. The focus on the hands gives you a place to go until the next breath returns, all the while keeping you present.

When I first tried this, I thought I was “cheating” because I wasn’t staying with the breath. And I had to remind myself that the purpose of this wasn’t to earn a gold star for being the best “focus-on-only-the-breath” meditator. It was to stay with whatever was happening “now”.

Allowing a slight change in focus when my mind is active keeps me present. Staying present calms me more effectively. And that helps me return to the meditation cushion day after day after day.

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There is beauty in the stillness that we experience between breaths. This dual focus practice isn’t meant to pull us away from that. Rather, it gives us a focus for those days when the mind is active and easily distracted, and appreciating that stillness is not available to us.

Is It Metastasis or Menopause?

Ever get the funny feeling that something’s wrong?

Like things are a bit “off” but you can’t be sure? I’ve been dealing with that ever since I got off letrozole, an endocrine therapy for breast cancer with a reputation for being difficult to take.

As of this posting, I’ve been off letrozole for 117 days exactly–yes, I’m counting. I’m still shaking off side effects like stupid-crazy joint stiffness, but at least I can tell things have improved.

That’s not what I’m talking about here.

I’ve taken a few rides in the MRI tube already. Not in any hurry to repeat that.

Right now I’m having some “really intense” memory and focus issues. I’ve put “really intense” in quotes, because I talk in superlatives so that my concerns are taken seriously. It’s a bad habit, especially when speaking to an oncologist, because it’s a sure way to end up in an MRI tube. Again.

In the past, my oncologist suggested that my memory problems might have been related to anxiety and not the medications I was on. That’s quite possible, although it’s hard to tease apart “anxiety” and “med side effects”. I mean, simply being told you have cancer causes an immediate spike of the Stress-O-Meter. For someone as anxiety-prone as me, it’s like I’m constantly red-lining.

Now I’m off the endocrine therapy and my memory and distractibility seem to have gotten even worse. What I had before wasn’t like THIS.

It’s kind of like saying, “This hurts. I think I’m being hit on the head with a hammer.” But then you actually get hit by a hammer, and think, “WHOA, now THIS is being hit on the head with a hammer!”

If thoughts are beads on a string, my beads are dropping off at a constant rate, leaving me wondering what I was about to do three seconds ago. And getting distracted by shiny objects. Couple that with having to learn a complex new financial system for work (grrrrr, Larry Ellison), not having helpful documentation to do so and having to go through that while being mainly confined to my bedroom for over a year…yeah, it’s a mess.

I am not being rational and I know it. But I’m still on high alert and dialing my fears down is going to take time.

Because my breast cancer was HER2+–which has been associated with metastases to the brain–my anxious little self immediately thinks, “Wait, maybe this is cancer’s spread stealing my thoughts???” I think that I will forever be jumping to that as the first possibility.

That’s not completely unreasonable, either. According to “Medical News Today”, memory problems are listed as one of the symptoms of brain metastases, along with headaches, stroke, seizures, confusion, dizziness…okay not really experiencing any of those.

And the Mayo Clinic metastasis website asks: what are the most likely causes of my symptoms? So, I admit, a brain tumor probably isn’t, given all the other more likely possibilities: menopause, work stress, loneliness, lack of purpose…and *cough* listening to Twitch video streams while I’m trying to focus.

So really, these memory issues could be a completely normal effect of menopause, but in the cancer context the possibilities are frightening. It takes a lot of perspective to be able to look at what’s going on and realize that it’s not aberrant or dangerous. I feel like an idiot for jumping to the worst conclusions, but here I am…

It’s a survivor thing.

Grounding Through the Fingertips: Hand Steepling

Note: this is another grounding technique, by which I mean a way to retain focus on what is happening in the “now” rather than getting lost in memories of the past, which we cannot change, or succumbing to fears about what may happen in the future. It’s not a woo-woo magical technique. It’s merely being mindful about what is currently taking place so that you can respond appropriately and maintain your composure.

During acute stress, we need to bring ourselves back to the present quickly. By doing so, we are able to clear our heads of the “what-ifs” and “you shouldas” that cloud our thoughts at those times.

But what’s the fastest way to do that? For me, it’s definitely focusing on the fingertips. Each fingertip has approximately 3,000 nerve endings, more than any other part of the body (except the most intimate). When you touch something, all those nerves start firing.

You can take advantage of this sensitivity to ground yourself.

Channel Benedict Cumberbatch’s Sherlock and put your fingertips together.

This is what I do: I “steeple” my fingers (thumb against thumb, index finger against index finger, etc.) as if I were Star Trek‘s Mr. Spock contemplating a complex situation. The fingertip pressure immediately commands attention from my fearful mind in the same way that a boss displaying that hand gesture would command an employee’s attention. Taking deeper breaths, I rub my fingertips against each other in a circular motion. The movement enables the nerve endings on the fingertips to keep firing as the sensation continues. Or I can bounce my fingertips off each other, or keep them together but flex the fingers to create a pulsing motion.

Closing my eyes accentuates the emphasis on sensation and makes maintaining focus on it easier.

Yes, this seems so simple, but it’s also quite effective. By placing our focus on the fingertips, we take our attention away from more reactive parts of the body like the chest area, where the heart might be beating fast and ribcage expanding and contracting with rapid breathing. Feeling into those areas might only serve to reinforce the heightened emotions that we’re experiencing.

The hands lie further away from that commotion, and that distance between the chest and our fingertip sensations enables us, if even for a short while, to get some perspective. Think of it as the anxiety not being “in your face”.

We can use body sensations as anchors to help stabilize us through anxious times.

Sometimes, when I close my eyes, all I “see” is that sensation of fingertip to fingertip, as if it’s the only thing that exists. I can play with this, imagining that I’m holding something between my hands, and that the sensation I feel is actually the feeling of that object against my fingers. It can be a pane of glass or even a beach ball. It all depends on what my brain is willing to accept at the moment. It’s a relaxing mental exercise.

As with many things related to mindfulness, it’s helpful to practice this fingertip pose when we’re in a relaxed and meditative state to connect the sensation to a feeling of calm, enabling it to serve as an anchor when our emotional seas are rough. The more we practice, the stronger that association, and the more effective the grounding response when we use this technique in the midst of anxiety.

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Fun fact: body language experts consider steepled fingers to be an expression of confidence. That might be the little boost you need when you’re navigating a stressful event!

Mental Grounding Through the Roof of Your Mouth

Okay, this is going to sound weird, but I’ve found that this really works.

A little background: in the midst of a stressful situation, I struggle with staying present and grounded. While I try to focus on and slow my breathing, that can be ineffective, since my heart is often beating quickly and, you guessed it, focusing on my breath brings me to close to my heart. It’s hard to ignore the pounding.

I’ve written before about turning attention to the extremities, in particular the hands and feet, feeling into the sensations there, since they are as far as you can get from your heart and still be in your body.

But most of us are very aware of our hands and even our feet since we get signals from them all day long as we manipulate objects and walk around. It’s not a new sensation. Even digging your nails into the palm of your hands may end up as a stressor of its own (ow!).

Granted, we’re not hippos. But IF we were, we would have a whole lotta palate to explore!

However, one place in our body that can still elicit novel sensations is the roof of the mouth. Even for someone like me, who often scratches my palate with hard veggie stems and uses my tongue to feel around up there, the ridges and other surfaces still seem new and unexplored.

Imagine that you’re drawing a topographical map of the inside of the mouth: feel where the teeth sit in the gums, and the hard area to the inside of the teeth traveling deeper in, how that hard ridge drops off into the concave part of the hard palate, curving up and then softening into the soft palate.

One of the supposed benefits of stroking the roof of the mouth with the tongue is that doing so can purportedly stimulate the vagus nerve, and thereby the parasympathetic nervous system, because the vagus nerve rests close to the surface of the inside of the mouth. All of this may have a calming effect, which is exactly what you’re looking for.

Just thinking about the sourness of biting into a lemon makes my salivary glands go bonkers!

It’s also worth noting that in the throes of stressful situations, our mouths tend to dry out. Something to try the next time you’re anxious and cotton-mouthed: elicit salivation by simply thinking about something extremely sour–imagine biting into a slice of lemon. Try that now, visualize it as realistically as you can, and chances are your salivary glands will respond. Mine are just writing about this!

When you are able to focus on bodily sensations you bring yourself back to the reality of the here and now. It removes you from the fear of what may be, and gives you the opportunity to come back to Earth, take a deep breath and carry on.

So next time you are feeling overwhelmed, see if you can allow the novelty of the roof of your mouth to buy you some breathing room.

Invisible Effects: Helplessness

Suffice it to say, simply having cancer can leave you feeling helpless. Ignorance of the cause, uncertainty about the future, fear of treatment effects — that lack of control is frightening. But that’s not the helplessness that I’m writing about here.

In my last post on chemo brain, I alluded to the disorientation that comes from distractedness, brought on by lasting effects of chemotherapy on brain function. Here, I want to drill down and describe the feelings of helplessness that arise. 

In WHY Did I Just Do That?, I wrote about a humorous dream in which I couldn’t understand the reasons for my weird behaviors. But the more sobering side of this is that I often feel that same way during my waking hours. There are things that I’ve done — treating a red light like a stop sign, as mentioned in my previous post — that make absolutely no sense to me and make me feel like I’m not in control of my own behaviors.

To make matters worse, I am not aware that I’m doing anything wrong (or dangerous or illegal!) at the time. When I realize what I’ve done, I’m horrified. Want to feel helpless? Not being able to trust yourself is a pretty good way.

I’ve been told that the main issue is loss of focus. Mindfulness helps immensely in these types of situations, but as anyone who has practiced mindfulness can tell you, you can’t be mindful 100% of the time. In my case, I’m fearful that this distractedness can put others or myself at risk.

This.

Want a few more examples? Some are rather benign, like almost flooding the bathroom because I left the water running in the sink. Or writing an important email and leaving it unsent. Most of us have done something like that at one time or another, likely due to juggling too many tasks at once.

But the things that leave me feeling desperate are the ones that are not easily remedied. Having to learn things over and over again because I’m not retaining information. Having trouble expressing myself and not being able to retrieve words. After working as an editor at one point, this is unbelievably disheartening.

However, one event topped them all: I fell for a (well-designed, admittedly) bank scam where I gave out my Social Security Number despite having taken my work’s cybersecurity training course the previous week, and having received constant reminders from my bank that they will never ask for my SSN over the phone. Besides making me feel unimaginably STUPID, it cost me a good deal of money, time and nerves. 

“Helpless” is not even the best word to describe how I feel. “Hopeless” is a more apt term. “Exposed” and “vulnerable” work too. This begs the question: how much more damage will I do to myself before things start improving? I should be working full-time instead of part-time, given the cost of living in my area. But how can I even think of looking for another job when I’m on such shaky ground? Cancer knocked me down in ways that I never anticipated. Yes, I’m grateful for being alive, but YEESH!

Building new neuronal connections, identifying what aspects of my memory issues are most severe, practicing mindfulness as much as humanly possible — it will take all that, along with a healthy dose of patience, to start seeing improvement. Hope I don’t get distracted and drive off a cliff before then.

Peace In Puzzle Pieces

One unexpected thing that had a big influence on me in terms of feeling support from others was a jigsaw puzzle in the oncological radiology’s waiting room. It was a large puzzle with a lot of pieces. Every day for six weeks, as I received radiation treatment, I saw that puzzle in various stages of progress. Eventually, I started poking around at it, and often I would be able to add a piece or two. The next day I came, more would have been completed — seems like a lot of us were poking!

This served as a lovely metaphor for what we, as patients, were going through: cancer is a puzzle, and treatment offers pieces that we put together in hope of finding our way through. All of us were working on this jigsaw puzzle at different levels of ability. Some were stronger than others, some had better support networks, but everyone was shuffling along at their own pace, completing their treatment puzzle, piece by piece, day by day. On days when treatment seemed never-ending, there was gratification to be found in the progress of the jigsaw puzzle.

I had never realized that working on jigsaw puzzles was so soothing. Just as in mindfulness meditation where you focus on the breath, the puzzle offers an opportunity to focus on a particular pattern, color or shape of a piece. It requires concentration, but this concentration comes easily. You don’t have to make yourself focus, it simply happens as you search for a piece.

Eventually, my radiation treatment ended and I left a partially completed puzzle in that cozy waiting room for others to finish, but I longed for that familiar feeling of comfort and quiet. That waiting room had been an inviting sanctuary where my only responsibility was to practice self-care. I wanted that to continue. It wasn’t long before I’d found puzzles to work on at home. I chose the images for how they made me feel, and for quite a few months afterwards, working on puzzles was a meditation. My family played the role of other patients, and together we enjoyed the satisfaction of putting the pieces together.

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Here are several of the puzzles I/we finished at home. Apologies again: as with most other photos in this blog, I never intended to post these online, so the photo quality is lacking. I’ve added info on where these puzzles can be found in case anyone is interested, especially if you’d like to see what the pictures look like under ideal conditions.

“Secret Garden” by Alan Giana (Bits & Pieces, 500 pcs, Amazon.com): I was looking for a peaceful oasis and this image fit the bill. I loved the flowers and flying creatures, but particularly the koi, which brought a special zen to the picture. (Bad lighting – doesn’t do it justice!)

Summer_Puzzle

“Marvelous Garden” by¬†Oleg Gavrilov (Bits & Pieces, 500 pcs, Amazon.com): I love peacock blue, the architecture smacked of Tuscanny and the flowers (yes, pink ones) completed the scene. This remains my favorite puzzle to date.

Peacock_Puzzle

“Autumn Oasis II” by Alan Giana (Bits & Pieces, 500 pcs, Amazon.com): Autumn means that Halloween/Thanksgiving/Christmas are coming up soon, and after such a miserable year of fear and cancer treatments, I was so looking forward to a joyous holiday season.

Autumn_Puzzle

“Florence” by Eric Dowdle (Dowdle Puzzles, 500 pcs, dowdlefolkart.com but purchased at Costco): I missed visiting Florence during a European trip due to scheduling conflicts, but it remains one of my most-wanted cities to tour. Seeing Michelangelo’s David in person is on my bucket list! I particularly liked that this puzzle came with a little poster of the image that made putting it together a serene pleasure. The last thing you want is to get headache trying to match up teeny windows!

Florence_Puzzle

A Year With Tamoxifen

One of the most distressing parts of going through cancer treatment was that I thought it would “ruin everything”, even if it saved my life. Physically, I was really enjoying my 50s and hadn’t noticed much of a drop in endurance and strength, and certainly wasn’t experiencing menopausal symptoms. But with my diagnosis came the news that, because I had an estrogen receptor positive tumor, I’d need to be taking estrogen-blocking Tamoxifen (or an aromatase inhibitor) for a decade.

A decade is a long time! Chemo was only six courses over about four months and radiation lasted only six weeks — all time-limited and psychologically doable. But Tamoxifen would be with me for ten years, and presumably, so would the troublesome side effects, according to just about every woman who was taking it. They spoke about how difficult it was to stick to the daily regimen, knowing that it was responsible for horrible hot flashes and night sweats — one woman even said that she couldn’t exercise due to the severity of her symptoms.

Not exercise?!?! My version of hell: a sedentary existence.

At this point, I was busy dying a thousand deaths. I started to question whether death by cancer was a preferable alternative to a decade of misery. Mind you, I hadn’t even begun taking Tamoxifen yet; all of this was fear-driven. I feared having no control over my own existence and the things that really mattered to me. Basically, this was an end to life as I knew it.

So, fast forward to today. I have been on Tamoxifen for a year. I’m still waiting for the misery. Please note, I do not, for a second, doubt that women struggle with Tamoxifen’s side effects and I have the utmost sympathy for them. I also realize that I’ve been very fortunate so far to not have those types of symptoms. Sometimes I feel a little warm and have to roll up my sleeves or take off a sweater. Being in stuffy rooms can feel uncomfortable. But these don’t constitute what has been described to me as a hot flash, and I cannot recall whether I had those same sensations prior to treatment. Before my diagnosis, I’d had some sweaty nights from stress; I haven’t had a single night like that since starting Tamoxifen.

I do have some memory issues, particularly distractibility and loss of focus. Sticking to one thing at a time is an absolute necessity or else I’ll get sidetracked. My libido took a hit too. But is that Tamoxifen, effects of chemo…or just the onset of menopause?

The bottom line is, I had beaten myself up over potential effects of a medication way before I’d experienced it. I’d ignored the number one rule of cancer: everyone’s experience is different. Oddly enough, that had been the mantra I repeated to everyone else, but I’m the one who needed the reminder. For me, Tamoxifen has not turned out to be the torture that I’d expected.

If there’s a take-home message from this, it’s that cancer is a complex disease and its treatment is equally complex. Just as there is personalized medicine, there are individual reactions to that medicine. I, for one, have convinced myself that I need to stay off the Internet, take a deep breath and have my own experience.

When Deep Breaths Don’t Calm

It’s an obvious understatement to say that getting cancer is stressful.

My treatment plan involved a lumpectomy first, then chemo and radiation, but just getting to the surgery wore me out emotionally. I’ve written before that I’d never experienced anesthesia before, certainly never had major surgery…and add to that, the surgery would confirm how far my cancer had spread so I was apprehensive about the whole thing.

Suffice it to say, I didn’t handle this process well. Two weeks prior to surgery, I had begun a mindfulness meditation practice at the suggestion of my radiation oncologist. This was a life-changing step for me, but I hadn’t had enough experience with meditation for it to truly benefit me as I was sitting in the “ready room”, waiting for my surgeon. I knew I had to breathe, but it was hard to focus when I was terrified.

The “breathe deeply” mantra was repeated by a number of nurses, probably because I looked like a wreck. I can honestly say that breathing deeply, as hard as I tried, didn’t work. Months later, I came across an article (and unfortunately, I cannot recall whom to credit for this) addressing this issue. The problem with focusing on the breath during periods of extreme anxiety is that the breath is most obvious in the center of the body. You know, right where your racing heart is. I couldn’t separate out the two, and as I was trying to slow my breathing, I was acutely aware of the pounding in my chest.

So, here’s the advice that I would give now: find a comfortable position and focus on your hands. Feel into them and focus on any sensations present in them. Fingers are sensitive, so it’s likely that you’ll feel something. Is there tingling there? Are they numb?What’s the texture of the material that they’re resting against? If you feel nothing, rub your hands together and focus on those sensations.While this type of meditation (essentially a body scan) is often done with eyes closed, depending on the individual and how frightening the surroundings are, it might even work better to keep the eyes open and look at the hands. But really look, so that you draw your attention away from the beating heart, and then gradually try to slow your breathing.

The idea is to keep your attention away from parts of the body that remind you of how anxious you are.

I can’t say that I would have completely relaxed had I known to do this. I had been dealing with runaway anxiety for the past weeks that my rudimentary meditation had only begun to chip away at. But it’s possible that I would have gotten myself into a more comfortable state as I waited for surgery. Definitely worth trying the next time you find that a breath focus doesn’t help with anxiety.