The Magic of the Exhale

If there is one thing that I can point to that has had the most profound effect on my reaction to anxiety-provoking stimuli, and also brought more calm into my entire day, it is deep, diaphragmatic breathing.

Diaphragmatic breathing (sometimes referred to as “belly breathing”) is an effective way to bring air into the lungs than simply inhaling into the chest. As the belly pushes outward, it pulls the diaphragm down, allowing the lungs to fully inflate.

This deep breath, in conjunction with my favorite breathing pattern — Dr. Andrew Weil’s 4-count inhale, 7-count hold, 8-count exhale — is what I call my magic pill. I have found this type of breathing to be very soothing. Dr. Weil based the 4-7-8 pattern on pranayama, an ancient yogic breathing technique, but the benefits are well-supported by modern science (Gerritsen & Band, 2018, Front Hum Neurosci, for example).

Neuroscientifically Challenged presents a short video introduction to the vagus nerve: “2-Minute Neuroscience: Vagus Nerve (Cranial Nerve X)“. It’s everything you never knew you really needed to know about the vagus nerve.

For me, it is the extended exhalation that is key. When the length of the exhale equals or particularly exceeds that of the inhale, a signal is sent to the vagus nerve. The vagus nerve is the 10th cranial nerve, and the longest one, running from the brain down to the abdomen, innervating a number of major organs along the way. The vagus nerve is also a major part of the parasympathetic nervous system (think: “rest and digest”) (Breit et al., 2017, Front Psychiatry).

The extended exhale has been shown to increase heart rate variability (HRV), slow down the heart rate itself and relax the body. HRV “represents the healthy fluctuation in beat-to-beat intervals of a human or animal’s heart rate. … Higher HRV is associated with stronger vagus nerve function, lower chronic stress levels, better overall health, and improved cognition” (Bergland, 2019, Psychology Today).

When I notice that I’m rushing through my day or experience wakefulness in the middle of the night, I have learned to turn my attention to my breath. Regardless of whether or not I’m feeling anxious, I often find myself breathing more rapidly and shallowly (chest breathing). As soon as I become aware of this, I take a deep, diaphragmatic breath and deliberately extend the exhale.

That first deep breath makes me realize how much I needed to slow things down.

That first deep breath is like putting the breaks on a runaway locomotive. It make take several more breaths to fall into that full pattern. I don’t force it — I simply allow each breath to be slower and deeper than the previous one. The sense of grounding feels amazing. I keep a lot of tension in my neck and shoulders, so I take care to release those muscles with each exhale. The result is that I feel a gentle sinking and relaxing.

One of the ways that I’ve benefitted most significantly by taking a “breath break” like this is that it has linked my formal, “on-the-cushion” meditation to the rest of my life. Even after I had established a daily meditation practice, I struggled to bring that same sense of calm into the rest of my day. Breathwork was the missing piece of the puzzle.

This deep breathing slows the overwhelming rush of sensations and provides an immediate connection to “now”, inviting stillness and spaciousness. Noticing my breathing in the midst of chaos exercises mindfulness. All this results in a sense of contentment and well-being.

Who wouldn’t want that?

How Mindfulness Helped Me Enjoy Cleaning

Full confession here: For years (ahem, decades), I disliked cleaning. I understood the importance of keeping things clean and tidy. But I never connected a positive feeling with it. Even as an adult, I would put it off. And off. And then someone would want to stop by and I’d be filled with dread. Never was the disheveled state of my home as apparent to me as when an outsider walked though the front door. Suddenly, I saw everything with fresh eyes, and it didn’t look great.

My approach to cleaning changed when I did one small thing: I noticed that my life was not one big overwhelming mess. It was a series of little challenges. So, too, my home. I stopped looking at everything as a whole. The whole was overwhelming. The whole meant a day spent cleaning and organizing. It didn’t have to be like that.

Just as life is in flux, so is the order in your home. Think of is as a wave, never, standing still. Things fall out of order and then are put back in order. Consistency in effort is what gives music to the dance. So you never have to “miss it”.

When I started looking at the work as distinct items, it was so much easier to take care of things. A small pile of papers. Scrubbing out the kitchen sink. Cleaning three windows.

It was that simple. I stopped thinking about “all the stuff I need to do”. Instead, I thought, “Oh, look! This is done already.” The boost of positivity that I got from taking care of the finite tasks was infinitely rewarding.

Most importantly, I made this a working meditation. My focus was on “now”. Scrubbing this spot of the bathtub. When it was done, I went to another spot. And that way traveled around the bathroom and out to other rooms until I was done for the time being. The rhythm made the day bright.

My personal strategy for cleaning mindfully:

  1. Set a timer for a reasonable amount of time, say, 10-15 minutes — you will quickly find a time that’s right for you based on how much you bristle when it’s time to start. Pick out a manageable “project” (or perhaps several) that you can get done during that time. Start when the timer starts. When the alarm rings, you’re done.
  2. Whatever you are doing, do it with a focus on the present moment. Give your full attention to what you’re working on. This is not the time to worry about what else needs to be done — stay with what you’re doing now, just as you would stay with your breath during meditation.
  3. Decide to do it again tomorrow. That stuff you did today? It’s done and no one can take that away from you, so whatever you do tomorrow only adds to the satisfaction of moving forward. Consistency is what makes this strategy work.
  4. Bring lightness and joy to the task. Play music, run an essential oil diffuser. Mark your success with staying on task by bringing in fresh flowers, even just foliage clippings in a colorful vase. Help yourself feel positive through the process. THIS IS NOT A PUNISHMENT.
  5. Pick up after yourself throughout the day. There is great power in putting things away right after you’re done with them. It feels so silly to even have to write that, but trust me, it’s a useful reminder, and one that I needed until it became a habit. (Who am I kidding? I STILL need the reminder.)
  6. The corollary to #5 is not to procrastinate on starting. If you start now and recycle five papers that you don’t need, there will be five fewer papers cluttering your desk. If you do that again tomorrow, that will be ten. Do it now. I have missed out on so many wonderful opportunities in my life because I put things off, a clean home being the least of them.
  7. Notice how good it makes you feel to invite order into your life.
I feel unsettled simply looking at this image. The disarray elicits anxiety, like I’ve lost something important, with little hope of easily getting it back.

I’ve found that the state of my surroundings is representative of my emotional state. And my emotional state likewise responds to the environment around me. When I was diagnosed with breast cancer, my world crumbled around me, physically and emotionally. Everything felt out of control and my surroundings reinforced that sense of despair. It took months for me to finally get a grip and move past the overwhelm.

Bringing order into my life was like an anchor that helped me recover, in many senses of the word. When I focused on what was good in my world, I spent less time worrying about what was wrong.

I’m betting you have 10 minutes in your day…

Mindfulness Apps I Love: “Unwind”

Disclosure: I was approached by Unwind‘s developer to review their breathing app and offered a free upgrade. I appreciated the suggestion to try Unwind because these days I’m all about breathwork. In addition, upon reading about the app in the iPhone App Store, I was impressed with both the concept and the developer’s sincere responsiveness to user comments. You can find it in there App Store here.

I’ve been using the Unwind app for a number of weeks now. It is a lovely breath-focused app with a number of unique features that I love, customizable and easy to use.

Unwind offers three breath exercises, all of which I which I recognized as science-backed for specific purposes: (1) the “Start fresh” pattern (6 counts in, 3 counts out) which brings oxygen into the body and energizes you; (2) the “Relax & unwind” pattern, great for a relaxation break during the day (4 counts in, hold for 4 counts, 4 counts out, hold for 4 counts); (3) the “Sleep better” pattern, perfect for deep relaxation before bed (4 counts in, for 7 counts, 8 counts out).

The user can pair these patterns with a specific ambiance. An ambiance is a themed background soundscape, and Unwind offers a broad range with options such as Rainforest, Rain on Umbrella, Village Backyard, Open Air Cafe, Japanese Pagoda…including unique ones that I haven’t found in similar apps such as Deep Space, Swimming with Whales, Castle and City Skyline with Ocean. At last count, there were 33, so there’s a flavor for every mood.

Breathing in, the landscape moves up.
Breathing out, the landscape moves down.

Each ambiance has a visual associated with it, and I really like the way the breath is represented in Unwind. In other apps, the breath is often shown as a ball, but in Unwind, it’s the selected ambiance’s landscape, with a foreground and background layer rising and lowering with the inhalation and exhalation. The images are uncomplicated and not distracting, but easily recognizable. There are also additional visual cues: a circle that represents time elapsed in a session and a line that represents breath “hold” time.

Sometimes I play an ambiance by itself, allowing my imagination to create my own imagery, or simply to use it as background sounds while I’m working or drifting off to sleep.

The settings give you a variety of options for customization.

You can chose between a male and female voice for inhalation/exhalation guidance: “Seth” or “Emma”. I’ve tried both and found that I’m more drawn to Emma’s voice, but I appreciate the ability to switch between the two. Also, it seems like there’s a slight change in voice inflection between some of the guidance cues, so even though the spoken words are the same, it doesn’t feel like you’re listening to a robot. That’s nice attention to detail!

This is the ultimate in making the app your own: you can stick with the pre-set breath exercises, or modify them to your liking.

Another lovely customization is the ability to adjust the breath lengths for each of the breathing exercises. While the established counts are research-supported, if, for example, the 7-count hold happens to be too long for you, you can adjust it. This means that you have the ability to completely personalize your breathing patterns, a valuable feature that I don’t usually find in apps like this. Of course, you can also choose the total length of each breathing session.

Finally, after each session, you have the opportunity to select a little emoticon that represents your mood, and there’s space to write your thoughts, should you want to jot down a few notes.

Because I feel that mindfulness, relaxation and breathwork should be accessible to all and not limited to those who are able to pay, I held off on the upgrade that I was given to me so that I could try out the free version first. My experience was not diminished at all, and that was really important to me.

Eventually, I did upgrade, which gave me access to the entire list of ambiances, which otherwise are locked. However, even in the free version, you can access some (or all — sorry, I upgraded before I found out!) additional ambiances by maintaining your practice streak, which is a lovely perk. Upgrading also enables you see all your past sessions and notes. But there is no subscription, which sets Unwind apart from other apps of its kind. There’s only a flat, one-time fee (at this writing, $5.99). I really appreciate that and would have happily paid it myself!

The bottom line is that I love this breathing app! Its obvious that the developer put a lot of thought into it, with a definite focus on the needs of the user. Unwind is the ideal complement to the other meditation apps that I use, and perfect for whatever breathwork I want to do. Because most of the features are accessible without the upgrade, I recommend trying this out to see if it works for you. If you do decide to upgrade, it’s a small investment for immediate access to all the ambiances and logged notes, and in my mind, well worth it.

How Do You Want To Feel?

I’ve really been enjoying a guided meditation on Insight Timer by Australian trainer and life coach Emma Polette, entitled “Morning Visualisation Meditation”. In fact, it’s been the first meditation that I’ve done every morning for the past month. What makes me like it so much? It reminds me that I can choose the emotional state with which I enter into my day.

Emma facilitates this by instructing the listener to “allow yourself to feel how to want to feel today.” I love this concept! So many of us want to be calm or happy or courageous, but we look at it as a cognitive endeavor and get nowhere with it. Emma reminds us to actually feel what it feels like. If my goal is to feel peaceful, then I imagine what it would feel like, if I were actually peaceful – I generate those feelings in my body.

By feeling into the sensations of a positive state, we can lessen the severity of negative emotions. It takes consistency and practice, but is worth the effort.

This takes practice and focus, but the payoff is wonderful. Think of it as establishing a new habit – repetition is necessary in order to seal it into your daily routine. The more you bring up those feelings in your body and really feel into all the different sensations associated with them, the easier it is to invoke that feeling the next time. And that next time might be a time of stress, when you’re in particular need of soothing.

Just as you may associate a meditation cushion with a sense of grounding, or a certain time of the day with a mindful mood because that’s when you always meditate, you can also improve your ability to bring up positive sensations that help keep you present and calm. All it takes is consistent practice.

I should mention that this is not to suggest that if you’re feeling strong negative emotions or succumbing to anxiety it’s a flaw of some kind. There will be numerous occasions when we get swept up by distressing thoughts. Sometimes it will be hard to release them. And that’s okay.

But I find it very empowering to start my day in a positive frame of mind, knowing that I am not helpless against stressors. Just as how in mindfulness meditation when we realize that we’ve lost focus and have slipped down a rabbit hole, we simply return to the breath, we can also notice how it feels in our bodies to experience stress or anger or whatever negative emotion settles down on us.

It might be a tightness in the chest that shortens our breath and sends our heart racing. It might be a cold sensation in our stomach and lower abdomen that elicits nausea, or it may be a hot flush that toasts our cheeks. With the awareness of what we are experiencing in the moment, we can gently breathe through those bodily sensations, relax the agitation and then remember how it would feel to feel the more pleasant sensations that we’ve practiced every morning.

How would you rather be feeling right now? Can you feel it?

What I Learned By Feeding Virtual Fish

I wrote my previous post about Zen Koi 2 so that I could write you this one.

You’d think that with a lovely mindful smartphone game where there’s limited stress and little competition, I’d be able to sink into peaceful bliss every time I played. Oh, but no. After I fell in love with Zen Koi 2, I found myself engaging in rather unmindful behaviors.

No stress? I’ll create it! All I needed to do was swim my delightfully colorful koi around and nab a little morsel here and there. It wasn’t long before that turned into frantic darting around the pond, frustrated by the prey I wasn’t fast enough to easily catch, annoyed by lack of maneuverability (these abilities improve as you level up), incensed when a spiny pufferfish blocked my path or spikey plants slowed me down. Instead of creating space between myself and the game, I was sucked into it and treading virtual water frantically.

Mind you, there’s no time limit on playing this game, no detriment to your koi if you spend a lot of time in one area. The prey items never run out. All you need is patience…and a little perspective.

I needed more zen in my Zen Koi 2.

I had trouble releasing newly hatched koi, wanting to keep them in my separate, personal pond (which has very limited space), so that I could play with them again. All this, even though once a koi is hatched is it in your collection permanently, and if you release it, you can easily clone it and swim with it once more. So there’s absolutely no need to hold on. But I was grasping, unable to let go. My behavior didn’t make sense.

It really wasn’t until I found myself clenching my jaws and gripping my phone that I dawned on me that I wasn’t enjoying this. I was striving for the next level. What I had at the moment wasn’t good enough, I was always trying to increase my koi’s abilities or get to the next sigil. I wasn’t enjoying the beauty of the little fish I had now. As soon as a mating fish appeared, I started drawing Punnett squares in my head, calculating what color combinations would result, and whether I potentially needed the hatchling to complete a collection.

Clearly, this sort of behavior is *not* what I’m going for when practicing mindfulness. In fact, it is completely antithetical to it. The striving, grasping, inability to focus on “now” was very telling. These are, of course, digital creatures, color pixels on the screen. It was my mind that made them real, my mind that created the anxiety around the game. It was my mind that gave the game so much emotional power over me.

So much grasping. I can’t get back what I lost by holding on to things that can’t be.

So I was thinking. Isn’t that kind of like my relationship with my fears? They too are not real, and it’s likely that a majority of them will never be real. And yet I attach to them and let them drag me around, frustrating me, agitating me, and in general, making me miserable.

For me, my cancer “story” was about loss. Loss of hair, loss of energy, loss of hope, loss of time to do more in my life. And the more I had felt I lost, the more I clung to how I wanted things to be. But they couldn’t be like that. I had already realized that, but it wasn’t until I played that innocent little smartphone game that I saw how powerful my attachment was to the things I really needed to release.

So, the next time I played with my fish, I gave myself distance. When I found myself clinging, I took a deep breath and let go. I let go of the newly hatched koi, I let go of the need to be more than I already am, I let go of the fears about tomorrow. And nothing bad happened. My koi was still peacefully traversing its little pond. I was still sitting on the couch, phone in hand, just like before. It was a pleasantly grounding realization.

Spiny pufferfish be damned. I think I can do this.

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My need to hold on is like my cancer journey: still a work in progress. I don’t know what the future holds. But if I can make this moment a little more pleasant instead of mourning all my losses, then I will consider that a victory.

Mindfulness Apps I Love: “Zen Koi 2”

Note: I do not receive compensation for writing about apps. I highlight these products because I personally use them and have found them to be helpful. Hope you do too!

Zen Koi 2 works for me like a mindfulness/meditation app.

I admit that I would have never though of calling a smartphone game a “mindfulness app”, but as far as I’m concerned, Zen Koi 2 qualifies.

The concept is simple: lead your koi through a pond as it catches prey that it uses to magically craft into gems, which in turn are used to expand the size of the pond. The koi increases in abilities (speed, agility and rarity) and has the opportunity to mate with other koi (in a stylized, family-friendly kind of way).

The egg that’s produced has the possibility of hatching into one of several different koi, which you can gather into collections. The pond increases eight times, each one marked by a certain sigil (symbol), and at the last one, your koi ascends to a beautiful dragon by jumping over the dragon gate and establishing its place in the heavens, harkening back to the Chinese legend of the hero Dayu.

The koi is supercute, swimming around the pond and gulping the prey you select for it.

That’s the gist of the game. But what makes it a mindfulness app? The way it allows you to stay in the moment. There is no competition, and while, if you prefer, you can focus on completing the collections of different koi “sub-species”, or collecting dragons, the game is not lessened if you chose not to do so.

Both koi and prey are colorful and pleasingly cute. The pond looks peaceful and inviting. Catching the prey is easy, even though they get more evasive as the pond expands. Select a prey item and the koi swims up to it and gulps it.

At the last expansion of the pond, the koi jumps over the dragon gate and transforms into a colorful dragon.

Once you hatch an egg into a koi, you can release the fish if you don’t want to keep it. The koi remains in your collection, able to be cloned and played with again, “paid for” with easily-obtainable pearls that appear in pond flowers, as rewards, or, if you prefer, by watching ads. There is no time limit and your koi is never in danger. You don’t suffer any penalties by taking it slow. This is all about living in the moment, playfully chasing the prey needed for that given sigil level and enjoying the surroundings.

You also get a personal pond outside of gameplay to showcase several koi and decorate with plants and rocks as you wish.

What was my most definitive test of whether this worked as a mindfulness app for me? I woke in the wee hours of the morning with too many worries on my mind. Usually I meditate when this happens and I can fall back asleep, but last night my thoughts raced too much to allow that sort of calm. I popped open this app and after about 15 minutes of helping my koi meander through the pond, I found distance from my worries and was able to sleep a few more hours.

Zen Koi 2 is worth looking into if you’re interested in soothing, mindful distraction.

Regaining Control Through Mindful Living

As I mentioned in a previous post, I’ve really enjoyed the Coursera course, “Engineering Health: Introduction to Yoga and Physiology“, which I highly recommend. One of the recurring themes of the class that I’ve found particularly relevant is that of effecting incremental and meaningful epigenetic change through yoga and meditation.

The class lectures went through the physiological mechanisms by which this happens, and this information would be reason enough to incorporate mindfulness and breath-to-movement in one’s life. But for someone who’s experienced cancer, there’s something even more important: a sense of control.

For me, the most terrifying part of my cancer diagnosis was the lack of control over what was happening to me. First, my body had turned on me by cultivating a tumor, the ultimate goal of which was to take over my organs and kill me. Then, my doctors were giving me drugs that by design would kill certain parts of me, with the intention of taking out the tumor before it spread to really important parts of me (brain? liver? heart?).

My body was a battleground in the war between my rogue cells and modern medicine. I had to sit there and take collateral damage if I wanted a chance at survival.

Disclaimer: So I feel the need to stress here that we do not yet know how to reliably prevent the formation of cancerous tumors, but there are things that we can do to greatly lessen the risk. I’m willing to bet that managing stress would have a powerful impact on prevention.

While I did begin meditation at that time, had I started learning to deal with my anxiety and accompanying physiological responses years ago, I might have been able to sidestep the disease. There is science to this which I will cover in a later post, but my doctors *hate* it when I postulate possible causes of my tumor since if we could truly pinpoint the cause, we’d be able to cure the disease. However, given what we do know about stress and inflammation, I can guarantee that my stress response did not help in keeping me cancer-free!

In the Coursera class, Dr. Ali Seidenstein (NYU) explains, among other things, how the small positive changes that arise from learning to control the stress response by applying yoga and meditation affect your genetics. And this is key. While you’re born with a certain set of genes, the science of epigenetics describes how you can affect gene activity (think, turning a gene on or off) and thereby have a different outcome from someone else with the same gene.

Finally! Something that *I* can do that provides a rare sense of control in an uncontrollable situation! For a cancer survivor, this offers a nugget of hope to hold on to in the face of continuing medications that may or may not help your survival. Medicine is tested on a variety of individuals but there’s no guarantee that their success will translate into your own (news flash: cancer = no guarantees, period). But knowing that you can engage in behaviors that, when applied over time, will actually benefit you on a genetic level…that, my friends, is priceless.

Mindfulness Apps I Love: “Oak”

Oak is among the simplest meditation apps that I’ve tried. While it’s not as stripped down as The Breathing App, it really covers all one would need for a meditation practice.

The home tab – simple!

I love the aesthetics — the app has a soothing watercolor-like look to it that reminds me of a quiet, overcast morning, before the rest of the world has awoken. Navigation is very simple as there are only three basic elements to choose from: meditate, breathe and sleep. However, they’re quite enough.

Meditate offers three meditation options, all customizable in duration, instructor voice (male/female), background sounds and warm up (for those wanting to settle in before meditating). The three types of meditations are (1) Mindful, learning to focus on the breath; (2) Loving Kindness, cultivating compassion and empathy both for yourself and others; and (3) Unguided, with the choice of interval bells instead of spoken cues.

Choose your meditation and then customize it to your liking.

Again, very uncomplicated and accessible. Both the male and female voices have that certain “something” that makes them soothing and easy on the ears. While Oak doesn’t have the expansive meditation libraries that some apps provide, for many meditators what Oak offers will be quite enough, and the ability to customize the meditations creates far more permutations than one might expect.

Breathe is the section of this app that I personally use the most. It consists of three types of breathing exercises: (1) Deep Calm, which has been advocated by Dr. Andrew Weil and has a 4-second inhale, 7-second hold and 8-second exhale; (2) Box breathing, which is a square “box” of inhale-hold-exhale-hold, each segment being 4 seconds long; and (3) Awake, which is a 6-second inhale followed by a brief 2-second exhale.

The number of breaths per “set” for each of these exercises differs, and you are limited to the number of totals sets you can do at a given time. However, this is probably a good idea because it’s important to take breaks when doing prescribed breathing in these ways. Think of it as insurance against passing out.

Not just for sleep! I can choose from a variety of sounds to fill the empty voids in my workday.

Sleep offers (1) Relaxing Sounds and (2) Guided Breath. Again, there are options for the background sounds and duration. I enjoy using the sound “elevate” at work, not for sleep (!) but to offer gentle music to even out the frustrations that may complicate my day.

There is also a 10-session course on Mantra Meditation. While I was able to unlock it for free, this may be a temporary benefit (perhaps due to COVID-19?) because the App Store makes mention of the course being available for a small fee. Keep that in mind for the future.

I had not been using a mantra for meditation, but this class helped me choose one and added another dimension to my meditation practice. The narrator’s voice was perfect for this type of lesson. The class is downloadable which leaves you no excuse not to meditate on your next plane flight. Note that I haven’t completed the entire course yet, so I cannot yet comment on its benefits as a whole.

Finally, Oak tracks your progress, including minutes meditated and number of breaths taken. It also shows the number of people meditating and breathing with you. And of course, it shows you your streaks. So, if there were something that I felt I need to gripe about with this app, it would be that it encourages me to focus on streaks. I can get pretty obsessive and competitive about these things, and unfortunately, Oak doesn’t let me turn them off.

On the other hand, tracking your progress is what allows you to gather badges while developing your meditation and breathing practice, so for anyone who’s interested in seeing visual reminders of their progress, this is a plus.

All things considered, this is a lovely app that you’re not likely to outgrow quickly. With the exception of possibly being charged for the course, everything else is absolutely FREE, which evokes the spirit of mindfulness being accessible to all. It also makes it completely risk-free to download and try for yourself. While I haven’t used Oak quite as much as I have other apps, I really do enjoy it and highly recommend it.

Mindfulness Apps I Love: “The Breathing App”

In my last post, I mentioned yogi Eddie Stern’s breathing app. If there were ever an app that exemplified the beautiful simplicity of mindfulness, this is is!

There are several things that make this mobile app perfect: (1) it does one thing and does it well, (2) it is uncomplicated, and (3) it’s absolutely free, with no in-app purchases.

This app is designed to help guide you in breathing. It is based on the concept of resonance frequency breathing, which is deep, slow, diaphragmatic breathing, between about 4-7 breaths a minute, depending on the individual — true resonance is considered to be six breaths a minute. Resonance breathing, “where oscillations in heart rate (HR) and breathing synchronize” (Pagaduan et al., 2019), has been shown to improve heart rate variability (HRV), which is “a key marker of health, mood, and adaptation” (Steffen et al., 2017). You may be familiar with HRV if you’re in training for a sport.

Set the timer, choose your breath intervals…

As Eddie Stern describes in his app and on his website, “by breathing at resonance, we enter into an even balance between the two branches of our autonomic nervous system, the sympathetic…and the parasympathetic…” The sympathetic is known as “fight-or-flight” and parasympathetic as “rest-and-digest”, and in our everyday lives, we tend to spend too much time with the sympathetic nervous system in charge.

…and inhale.

The Breathing App helps us balance out the two systems via resonance breathing. There are several elements to this app: (1) an informational page, with instructions on setting up and using the app, including info on the science and creators; (2) the breathing ball, which helps you visualize the breath; and (3) the sound breath guide, which provides a tone that guides your inhales and exhales.

You set the timer from 1 to 30 minutes, choose your inhale:exhale ratio (2:3 or 4:4 [for kids]; 4:6, 5:5, 6:6 [true resonance] or 5:7), and decide whether you’ll watch the ball or look at a starry sky, with or without the sound.

And that’s it.

There’s nothing to buy and practicing with it is simple. Of all the mindfulness/meditation apps that I use, this is one of my favorites and I use it to augment my yoga practice. Give it a try!

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Fun fact: some well-known names are credited as participating in the development of this app, including Deepak Chopra and musician Moby!

(Almost) Six Months on Letrozole

WARNING: IF YOU ARE STARTING ON AN AROMATASE INHIBITOR, I highly recommend that you not read this and instead give yourself the chance to gauge the medication’s effects without being influenced by someone else’s experiences. Note that I started letrozole just out of menopause, so my side effects from this drug have been more dramatic than they might be for a women who’s been postmenopausal for longer.

First a bit about aromatase inhibitors: according to breastcancer.org, “Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells.” Think of this as starving a hormone-positive cancer of its food.

Aromatase inhibitors have been shown to be more effective than tamoxifen, with fewer serious side effects, although they are certainly not risk-free as they can cause “more heart problems, more bone loss (osteoporosis), and more broken bones than tamoxifen.” (breastcancer.org)

When it was time to start letrozole, I took a different tack than when I began tamoxifen. For the latter drug, I did all the research I could, researching relevant studies, digging into possible side effects and visiting lots of forums to learn about what other women were experiencing.

I wish I hadn’t. I think all the negatives affected my perception and made me anxious about taking the medication.

The letrozole pill looks so teeny and cute – how bad could the side effects be?

So after two years of tamoxifen, when my hormone levels suggested that I was postmenopausal and it was time to switch to an aromatase inhibitor, I stayed away from clinical literature about letrozole. I decided to give it a chance, since my oncologist felt that I had confused the effects of anxiety about taking tamoxifen with the actual effects of tamoxifen.

Okay, then. As I was leaving my oncologist’s office, letrozole prescription in hand, he added that some women complain of “joint pain”. I think he felt it was his duty to warn me.

My experience? I’m finding it harder to recover from workouts. I train with free weights and am a rower (currently, indoor) and the change in my resilience and stamina is striking. In 2018, a year after finishing up chemo, I was able to power through tough workouts and felt like I’d gotten most of my pre-cancer strength back.

Fast-forward to now, just two years later, I feel old. My joints are creakier and I’m having increased muscle pain and overall stiffness. I’m experiencing bone pain in the leg that I broke skateboarding when I was 12. Yeah, I push through workouts, but they’re taking their toll on me.

I’m fortunate to have a full complement of gym equipment at home, so the COVID-19 lockdown didn’t hinder my workouts. To get some fresh air, I incorporated more hiking into my routine, in addition to my regular workouts.

It was too much and left me with hip pain that made it difficult to fall asleep. So I took a rare break from vigorous workouts and for two weeks incorporated more gentle movements and focused on yoga, which I had been doing intermittently.

When I started ramping back up, I didn’t feel rested, I felt weak! Weights that had been easy to lift a couple of weeks before felt challenging. I had to restart the process of building my strength. You could pass it off as simply “age”, but I’m only 54, and the drop in strength and energy has felt precipitous, even demoralizing. While it’s true that I went through menopause during the last two years, it was a medication-induced menopause and I was literally shoved through the change.

Letrozole has been shown to be very effective in preventing cancer recurrence, presumably because it works to keep estrogen levels low. However, most women on letrozole are in their 60s and have been postmenopausal for a number of years. For a woman in her 50s, the aging effect of estrogen suppression has felt dramatic.

My libido dipped even lower than I’d experienced with tamoxifen, something I was warned about by my GP and gynocologist (both females). My male oncologist didn’t talk about it. I believe this is a seriously underreported side effect of aromatase inhibitors and one that many women suffer from in silence, because they don’t feel comfortable bringing it up.

Likewise, I feel my appearance changed. Now, this may simply be my perception of myself, as my post-chemo hair transitioned from super-cool and spikey to thin and limp (and, now, untrimmed!), and my eyebrows never recovered. But it’s not just in my head: A bus driver recently tried to offer me a senior citizen discount, whereas four years ago someone had told me they thought I was in my late 30s! That’s a big difference. The fact that the lack of estrogen is making me look like I’m older than I really am has become distressing:

And that difference is felt in my relationship with my family. There have been times that I’ve looked at my husband (four years my junior) and my high school-aged kids, and I feel like don’t belong with them. I feel like a stranger, an old lady that’s just hanging around. That hurts a lot.

And on my worst days, I feel dark clouds rolling in, bringing with them frustration and hopelessness. Is it letrozole or menopause? Does it even matter? Take a woman, throw her in a bag, tie it to a tree branch and then beat it with a stick. That is how I feel when I have to take a pill that does these things to me. No control, no future, lots of pain. The longer that I continue with medications like this, the more I feel that they are pointless, since I’m starting to not care whether or not the cancer comes back. And that’s the worst side effect of all.

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So, this blog is about being honest about the cancer experience. But it’s also about mindfulness. I have to open the door and let the negative feelings into the room so that I can offer them compassion and a kind ear. I sit with them for a while, and eventually, I feel better.