Do we get what we expect?

I’m in the void between writing and publishing; that place where you send your baby book out to a few trusted people for what you hope are some minor corrections and constructive feedback.

And then you wait.

Early indications are that it’s readable and useful. I’m still on track to publish either late April or early March. I still don’t have a name I like. I started with ‘What if the Cancer Comes Back?’ but figured most people wouldn’t want to buy it. I moved on to ‘Worried Sick by Cancer’. Same problem. I really want a title that’s focused on what the book will help you to achieve, rather than the problem it’s trying to address.

Having said that, popular wisdom is that it needs the word ‘cancer’ in the title. Something to do with algorithms and search engines and online potential. I really like ‘Fear + Less’.
It’s a book about fearing less. But is this too obscure? And it doesn’t contain the word ‘cancer’. All thoughts and suggestions are welcome.

In the meantime, I’m contemplating the extent to which we get what we expect. I had coffee with a friend that hasn’t been to yoga for a few months. She hurt her foot and ended up in one of those ski boot looking things that they use instead of a cast. She was telling me that when it came off, her whole leg was wasted and that she’s still regaining strength.

Then she said this: “It will never be the same. I’m always going to walk with a limp.”

Hold on a minute. You’ve only had the boot off for a couple of weeks and you’ve already decided that you’ve got a permanent disability. When I asked her why she thought this she replied that her doctor had delivered this miserable diagnosis and that it reflected her own fears, so she saw no reason to reject it.

I reminded her that post-mastectomy I was told I’d be likely to experience some permanent restriction to my range of movement. It was likely that taking two F cup breasts from my body, and the subsequent scars running under my arms, would mean that my arms just wouldn’t be able to do what I was used to them doing. A combination of scar tissue and nerve damage would see to that.

When I put my hands above my head I still need to slightly adjust my left hand to bring it to the same height as my right. That’s it. Oh, I sometimes have some tightness to the left side if I twist. I can also put my hands into a reasonable ‘reverse prayer’ (put your hands into prayer position and now see if you can do the same thing behind your back), and a couple of weeks ago I held something called ‘crow pose’ for a good five seconds.

Crow pose involves crouching forward with your hands on the ground, putting your knees on the backs of your upper arms and then lifting your feet. Google for impressive pictures. Essentially, I can support my entire body weight on my upper arms.

I’m a 55 year old woman whose had a bilateral mastectomy.

I’m also close to four years since my diagnosis and a few months further away from three since my surgery. Recovery did not happen quickly. I still have some issues with my hands and my feet thanks to the nerve damage from chemotherapy and I also get annoying pain across various parts of my chest on a regular basis. It turns out that this is common post-mastectomy. I don’t accept that either condition is permanent.

I think of all the various aches and pains I’ve had during treatment, and all the way back throughout my life. What an amazing capacity our bodies have to heal. I also recognise that some recovery takes much longer. I think we have a mindset that a few weeks is a reasonable healing time because that’s about how long it takes for a cut to heal.

Here’s the thing. Skin heals quickly. It has to. It’s the outside, protective coating for our bodies. Other things heal more slowly.

I was told by my oncologist that whatever nerve damage I had at the end of twelve months was probably my ground zero. Things weren’t going to get any better. Then the radiation oncologist told me that nerves can take up to eight years to regrow. Eight years! So let’s wait until then before writing off my healing capability. Certainly things have improved slowly but if I’d accepted the first diagnosis I’d be focusing on the pain and discomfort and not bothering with physiotherapy to improve my condition.

I’ve recently read about some interesting research into chronic pain. People that experience it have a different kind of brain. Researchers can put 100 people through an MRI and detect which ones experience chronic pain by looking at the architecture of their brain. Here’s what’s really interesting; they can also predict which people will develop chronic pain using the same techniques.

It turns out that to some extent, pain really is all in our minds! At least, it’s more likely in those of us with a particular kind of mind.

This is huge. About one in five people report either chronic or sever pain. It’s the reason pharmaceutical companies invest so much money in pain relief. It also explains why so many of these medications affect brain chemistry.

This might sound like your propensity to experience chronic pain is just some kind of genetic lottery, but it’s more complex than that. A whole range of things directly impact the way our brain functions. It’s no surprise that chronic stress can cause exactly the kind of changes that result in chronic pain. People with higher levels of anxiety or depression are also at risk. Some recreational drugs, including alcohol, are also linked to the same kinds of changes in the brain that result in chronic pain.

So what about the brains of people that are less prone? Of course those with a calm disposition, and good techniques for coping with anxiety and stress do well. (Don’t ever let anyone try to tell you that there’s a human being on the planet that never experiences anxiety, stress, grief or anger.)

The robust mind might also belong to someone that used to be prone to chronic pain. These people have usually altered the way they live their lives to reduce stress and anxiety. They probably practice meditation regularly and may also use yoga, tai chi, qigong or some other form of calming exercise routine. Track these people over time and their MRI’s will show physical changes to their brains. They don’t cope with a pain-prone brain by soothing it, they actually change the architecture of their brains to something less likely to experience chronic pain.

Of course, what this means is that even my ‘permanent chronic pain’ diagnosis is now up for argument. It’s just possible that with yoga and meditation I can overcome pain. It’s certainly highly likely that I can reduce it.

I noticed a few months back when a visitor complained of a headache that our medicine chest was full of pain relief medication. I had stocked up on it, having been told I’d probably be taking it for the rest of my life. I couldn’t be sure about the last time I took anything but it was certainly months ago. I didn’t decide not to take the pills, or to endure serious pain. My pain just hadn’t been strong enough for me to want a pill.

There are still times when I consider medication, and still very rare times when I take something, but that’s a long way from six tablets a day. I think my progress is due, to a very large extent, to my daily yoga and meditation.

I also think that part of it is due to my expectation that we can always improve our health. There’s no upper limit to how well we can be. Ultimately, a doctor’s diagnosis is just an educated guess, an opinion based on what they thing other patients in similar circumstances have experienced.

Personally, I’d like to see doctors trained to talk about possibilities rather than absolutes. This isn’t about putting a shine on a bad situation. It’s about being accurate. I’d like to hear them use language like this:

Based on what we know about your condition there’s a possibility that you may have permanent pain or physical restriction and there’s also a possibility that you may not. The body has an amazing capacity for healing and it can sometimes take years before it’s finished the job of recovery. There’s a lot you can do to improve your health and there’s no upper limit to how well you can be.

I suppose we’re still years away from meditation being recommended, in spite of the overwhelming research that proves it’s more beneficial and more effective than any pharmaceutical your doctor can prescribe. Ideally, I’d like to see practices that included a psychologist to teach people the techniques they need to live a fulfilling life. I’m sure that would have more impact on public health than all the pills in the world.

Regardless of where you are with your own recovery, please know that nobody has the right to steal your hope. Doctors that make proclamations about your limits are sharing their opinions, and while they are very well informed opinions they are not a sentence. When it comes to recovery it’s best to keep an open mind. We may be capable of more than we think. Certainly we will never get more than we expect.

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How to Change Your Mind

There was another shooting this week.

This one was in the USA so it got lots of news coverage here. It could have been anywhere. All over the planet there are similar examples of violence and hatred. It feels like a vicious circle; a shooting happens and the response is anger and hatred, and the anger and hatred build and bounce until someone else snaps and the whole cycle starts again.

What to do.

If you’re a caring, compassionate person events like this one can leave you feeling hopeless. What’s to become of our species?

It’s an acute form of the same kind of distress we experience when we’re confronted with selfish, greedy people that don’t care about the planet or the other animals we share it with, or selfish, greedy people that don’t care about other people.

What to do?

I see friends responding with anger towards these types of events. There are cynical posts on Facebook, heart-felt expletives, conversations through teeth ground down by years of frustration.

And then an afternoon spent looking for something entirely different leads me to the work of Tania Singer. I was concerned about the way world events can be deeply distressing to highly empathic people. As an ex-police officer with a history of PTSD I now avoid the news. It’s just too upsetting. There’s so much research about how easy it is for us to ‘catch’ the emotional distress of others. So when I caught sight of this article in an issue of New Scientist I was drawn to it:

How Sharing Other People’s Feelings Can Make You Sick : New Scientist 2016

You’ll need to pay to read the whole article but if you’re the kind of person that’s deeply affected by distressing events I recommend it. Does this resonate with you:

Overdosing on the misfortunes of others is not just a problem for those in high-exposure professions such as nursing. All of us are vulnerable to catching the pain of others, making us angrier, unhappier, and possibly even sicker.

What was really interesting to me about this article was that the research done by Singer and her colleagues provides some great strategies for combating this distress. Teaching people how to meditate on loving kindness, and how to become better at observing their emotional responses to different situations can have a protective and healing impact.

Impressively, these processes can actually change your brain. Singer demonstrates using MRI’s how their program altered the neural activity in their research participants. She and her team have also demonstrated that these changes do more than just improve individual wellbeing; they also change the way we treat each other.

In tests that examine economic modelling and how people behave, Singer’s team established that meditation and other cognitive awareness practices shifted people’s behaviour from selfish to generous, from individualistic to cooperative.

If you’d like to learn more then here’s the link:
Tania Singer: How to Train Your Mind and Your Heart

This work relevant to anyone interested in social change and the evolution of our species beyond our current state. Compassion and extending loving kindness can change our brains and lead us to behave in more compassionate ways.

All those from religious traditions that believe meditation can change humanity are, in fact, correct.

The flip side of this is that a world filled with hate, cynicism and negativity has the potential to hard wire us for competition, greed and cynicism. When we give in to anger we’re doing to opposite of meditating on loving kindness and our brains (and lives) will suffer as a result.

I was on a course recently with a wonderful group of people that genuinely care about humanity and the planet. Even given this strong, positive bias I was surprised by the level of anger and negativity in some people. ‘The one percent’ came in for a lot of hatred, as did individuals seen as belonging to it. There was even some conflict within the group as some people decided who they did and didn’t connect with. Even here, there were the seeds of weeds that become violence.

Is it really as simple as loving everyone? Even the greedy and the violent, even the destructive and the selfish? And is that even possible?

There are reasons to practice meditation in any case. Evidence suggests it can protect your brain from the effects of ageing, provide you with a calmer, happier life and help you to overcome depression and anxiety. There are lots of free meditations available on the internet if you’d like to give it a try, or just do this:

  1. Find a comfortable, quiet place to sit. Hold your body in a neutral position – not too relaxed or too stiff. You want to be comfortable but you want to avoid falling asleep.
  2. You don’t have to close your eyes but many people find it helpful.
  3. Listen. What can you hear. Spend a few moments paying attention to the world around you.
  4. Now focus on your body and how it feels. Feel where it’s in contact with the chair. Feel your clothing against your skin.
  5. Shift your focus to your breathing. Notice that it’s cooler breathing in and warmer breathing out.
  6. Your mind will drift. This is normal. Be relaxed about it. Imagine that your mind is the sky and the thoughts that try to pull you away are like birds that fly across the sky. You can notice the bird and let it fly past. Bring your attention gently back to the sky.
  7. Now cultivate a feeling of loving kindness. Think of someone you love (If you struggle to think of a person then try a loved pet) and feel the emotion build up inside you. Imagine this feeling is like the sun, shining in the sky.
  8. Extend a feeling of loving kindness out into the world. Start with yourself. Bathe yourself in loving kindness. Then extend it to your close friends and family. Wish the very best for them; their health, their happiness and that they should also achieve peaceful and compassionate minds.
  9. Now extend loving kindness beyond the people that you know to the people that you don’t know. Remember this feeling is sunshine and it doesn’t discriminate; just like the sun it shines on everyone. If you struggle to shine loving kindness on some people, imagine them as small children or babies. Cultivate loving kindness towards all humanity.
  10. Now extend loving kindness to all life on earth. To trees and animals and microscopic life. To fungus and whales and chickens and lizards. Everything that lives can experience your loving sunshine.
  11. As you do this, your thoughts will continue to drift. This is normal. Just gently bring them back. You might like to imagine that your loving kindness is a river flowing out into the world and your distracting thoughts are like leaves on top of that water. Just let them float by.

You only need to set aside five or ten minutes a day to do this. After a while it becomes like cleaning your teeth. It’s just part of your routine. There are other ‘mindfulness’ practices like yoga and tai chi that will also help you to develop your meditation skill, but remember that it’s specifically a meditation on loving kindness and the practice of extending compassion to others that will have measurable benefits for you.

From personal experience, this practice has been extremely beneficial in helping me to live with post traumatic stress disorder. Part of my policing career involved child protection work, so you can imagine the challenges I face when it comes to extending loving kindness to all human beings.

But I do. Even to the offenders I’ve arrested. They were once children too.

Perhaps my greatest challenge has been to move beyond the anger and hatred that I used to feel for these people. They are not monsters, and treating them as monsters is only feeding the creature. I sometimes laugh at the realisation that The Beatles knew the answer and I’ve been hearing it all my life; Love really IS all you need.

I’m not saying it’s easy to avoid being pulled back into old patterns. When a shooting happens or I hear that the Great Barrier Reef is dying or I read that a politician has acted in a greedy, selfish way it’s simpler to just get angry and to launch into a rant. And then I remember that hate makes me part of the problem.

I sometimes wonder why adults that would not allow their children to bully other children with name-calling are perfectly okay with doing exactly the same thing to other adults via social media. Does calling Donald Trump a dickhead really make a difference? Or does it feed into the dynamic that allows him to exist at all.

One of the most common despairs of anyone passionate about the planet and the people on it is this: How do we change the minds of the destructive and selfish? It turns out that the answer was in our question the whole time: by changing their minds. Perhaps we need to focus on finding ways to engage these people in compassionate meditation. The research suggests it could shift their behaviour.

In the mean time, we can be the change we want in the world and work on refraining from the kind of behaviour that will make our brains like their brains. Could it be that simple? Maybe the next time you’re tempted to share an insulting thought or denigrate a public figure, pause and give thought to what you’re cultivating.

What’s most interesting to me about all of this new research is the extent to which it validates some very old philosophy. Buddhists have been teaching compassionate meditation for generations. The minds of Buddhist monks look very different under MRI analysis. They have changed their minds.

When events like mass shootings happen I am now able to avoid the anger and depression, not least of all because I recognise that these emotions feed the creature. Change is possible. We have the means for our own evolution. Spread the word.

Sleep Is The Great Healer

We spend a quarter to a third of our life doing it and yet there’s still so much about it that’s a mystery. Why do some people need nine hours of it and others thrive on only three or four? Why do we dream and what do our dreams mean? Why does the lack of sleep induce distress akin to mental illness? And the biggest question of all; Why do we sleep?

One thing has become really clear. Sleep is the great healer.

The extent to which it’s critical to our recovery was made clear to me in this excellent TED talk by Jill Bolte Taylor on stroke recovery where she explains how she rebuilt her brain. Prior to her stroke, Jill was a brain scientist so her insights are particularly fascinating.

Like many people she’s critical of the way hospitals are designed around staff rather than patients, with people being woken up at regular intervals to have their ‘vital signs’ checked. This is not conducive to recovery!

Most of us understand the importance of sleep but have you ever noticed how few people report sleeping well. It’s possibly the most important contribution we can make to good health, so here’s my collected wisdom on getting a good night’s shut eye.

When we remove those that sleep well for long enough and wake refreshed, we’re left with those that fall into one or more of the following groups:

  • Those that struggle to get to sleep
  • Those that struggle to stay asleep, waking once or several times a night
  • Those with a medical condition that directly impacts their sleep
  • Those that have been asleep for what should be long enough and yet wake feeling tired and unrefreshed by sleep.

Let’s start with the fourth group. If you’re in this category it’s worth having a sleep study done. The most common cause of un-refreshing sleep is apnea (which moves you up into the third group), a condition where you stop breathing intermittently while you sleep. In sever cases it can be life threatening. Even mild cases can have serious affects on your health. You can now get a sleep study kit that you take home overnight. You stick on the electrodes and climb into bed. A little suitcase records all of the information and you usually get a report back within a couple of weeks.

If you’re diagnosed with apnea there are a couple of options, including wearing a device that maintains air pressure while you sleep or having corrective surgery. My husband had surgery last year with great results and he’s now healthier, happier and has much more energy during the day. He couldn’t stand the CPAP machine but lots of people are huge fans.

There are other conditions that might put you in the third group including narcolepsy. These always need medical treatment and you should talk to your doctor about how to improve your condition. All of the other advice here about sleeping will help but some conditions really do need medical intervention.

If your sleep study shows that you don’t have apnea it might also give you some idea of why the quality of your sleep isn’t leaving you refreshed. It could be something as simple as not sleeping deeply enough and this can send you back to the bedroom to look for causes. Which is handy, because that’s exactly what we need to do for people in the first two categories.

Good conditions for sleep might seem proscriptive because we’ve all seen people that can apparently sleep just about anywhere. It’s true that most of us could fall asleep propped up against a wall if we were tired enough but it’s unlikely that the sleep we get would of a very good quality.

Sleep moves through cycles that usually last about 40 minutes. If something is regularly disrupting your sleep you’re not going to achieve the deepest levels of sleep that allow you to feel well rested. Obvious culprits include a snoring partner, a noisy environment or an enthusiastic nocturnal pet. Here’s a short check list of the ideal sleeping environment:

  • Dark; light on the outside of your eyelids triggers you to wake up.
  • Cool; the ideal temperature for sleep is around 18 degrees celsius which is much cooler than the 22 degrees we like when we’re moving around. If you’re in air conditioning it might be too warm (and too dry) to sleep well.
  • Quiet; even low level noise can disturb sleep. Most of us become accustomed to familiar noises which is why it’s possible for us to learn to sleep next to train lines or busy roads. We don’t stop listening when we sleep. Sudden and unusual noises will wake us up or disturb our sleep. Sometimes even the low buzz of an electronic device is enough to mess with our sleep patterns. Try moving the phone and charger or the electronic clock out of the bedroom.
    Unfortunately for some of us, our partner might be the source of the noise. In these cases it really is worth considering separate bedrooms if that’s possible. You can still spend time together before going to sleep or in the morning.
  • Comfortable; I think there’s a lot of hype and money in the mattress industry these days. Interestingly, most of the european population sleeps perfectly well on foam mattresses but in Australia we’re obsessed with the inner-spring. The best mattress is one that provides enough support to keep your back aligned along with enough padding to stop your bony bits becoming uncomfortable. I’ve avoided replacing my latex mattress by adding a topper to it in memory foam.
  • Clean; Dust mites, mould and allergens can all have a negative impact on your ability to sleep. Fresh air is also important and this can be a real problem if you can’t have windows open due to noise or live somewhere where the outside air is far from fresh. A portable air conditioner or dehumidifier is probably your only option here.
  • Un-interupted; I adore my cat. He comes in each morning for a cuddle. He doesn’t sleep with me because he thinks it’s a great idea to get up at 3.00am and run around the house like a deranged lunatic. When our sleep is interrupted it prevents us achieving deep sleep. Do what you can to protect your peace.

If you’re finding it hard to get to sleep or to stay asleep then start with your sleeping environment. A lot of people have solved their sleeping problems with some very minor adjustments, like black-out blinds or a thermostat adjustment.

If you’ve run a diagnostic on your bedroom, created the ideal sleeping environment and it’s still not happening for you then here’s a list of the most common things that disturb our sleep:

  • Overstimulation; we sleep best when we’ve spent the last hour or so of the evening winding down. Do whatever helps you to relax. The obvious exception to the overstimulation rule would be sex. Nothing beats an orgasm for facilitating sleep. Isn’t that good news!
  • Exposure to light in the blue spectrum; this signals our brain that it’s day time. Unfortunately computer screens and energy saving globes are both common sources of light in the blue spectrum. You can get an ap called f.lux that will adjust the light on your computer and you can also get ‘warm’ globes. Fortunately, exposure to light in the yellow/red range has the opposite effect so taking advantage of candle light and fire light will help you wind down.
  • Not enough sun; it seems odd that we need sunshine to sleep well but it turns out that eating our breakfast in the daylight is a great way to set our body clock. This is particularly important for people on shift work or those recovering from jet lag. When you wake up, go outside and get some sun. If your ‘morning’ occurs during darkness then you might want to invest in a light that simulates sunlight. This should improve your ability to get to sleep and the quality of that sleep.
  • Overindulgence; too much food or alcohol will disrupt your sleep. Alcohol might seem like a great way to unwind but it actually disrupts your sleep cycle and this (along with dehydration and altered brain chemistry) contributes to feeling hung over the next day.
  • Anxiety; a big favourite with those of us dealing with serious illness and this one deserves a book rather than a few lines. Luckily there have already been several great books written about dealing with anxiety. My favourite is Russ Harris’s ‘The Reality Slap’. Breathing exercises, meditation and yoga are also wonderful. Don’t just put up with it. It isn’t helping you to recover and it’s robbing you of your sleep. If it’s really bad then get counselling for it.
  • Pain; for many people it’s the great sleep thief. Fortunately there’s now been some great advances in managing chronic pain, including improvements in medication and a much wider range of medication-free strategies. Calming music, gentle exercise and meditation can all help with handling pain. So can hypnosis and counselling from a good psychologist (particularly one with ACT training). Massage and other ‘touch therapies’ are also excellent for helping to deal with pain.
  • Monkey Mind; I love this Buddhist term for the way our minds will jump around from one thing to another, never settling in one place. They recommend meditation and it certainly works well. Another great technique is to spend ten minutes listing all of the things that are occupying your thoughts. Write them down. Then you can put your head on the pillow and when ideas pop up you can thank your mind, remind it that you’ve already made a note of that for tomorrow and then relax.

My husband and I have both had periods of time where we kept waking up in the middle of the night, often at the same time every night. For me, a short passage in a book about the subconscious helped me to overcome this. It explained that when we spend all day talking about how we can’t sleep we’re actually programming ourselves not to sleep well. I started changing my internal dialogue to “I will sleep well and wake up feeling great” and I stopped talking to other people about my bad sleeping habits. This solved my problem.

My husband not only woke during the night, he then experienced annoyance and frustration at being awake. This, of course, made it much harder for him to get back to sleep again. Recently a friend shared an article about a bit of historical research that indicates it was once quite common for people to sleep twice during the night. It seems they would go to bed shortly after sunset, wake some time during the middle of the night, use that time to read or do bookwork by candle light, and then go back to bed for their ‘second sleep’. This has made a huge difference to Graham. He’s in the kind of job that he can dip in and out of and it’s often some sort of complex work problem that wakes him. Now he gets up, spends a couple of hours on it and then goes back to bed.

If you remember that sleep moves in roughly a 40 minute cycle then there’s no reason why we couldn’t break our sleep up into whatever sort of pattern works best for us. When my daughter was a baby the key to coping in the early weeks, when she had terrible sleeping patterns, came from a friend who suggested that I sleep whenever she slept. It seemed counterintuitive to me that grabbing a couple of hours here and there could make up for ‘a good night’s sleep’, but it did.

My other really interesting experience with sleep happened following my first surgery to remove the remaining tumour from my breast. I was in a shared ward with a woman that had been through reconstructive surgery. She was experiencing high levels of pain and was calling out with distress throughout the night in spite of the morphine pump. I put my headphones in and spent the night listening to calming yoga music and led meditations. I didn’t sleep. To my surprise I felt as refreshed the following day as if I’d had a really good sleep! This wasn’t a fluke. I now regularly use my iPod when I’m having difficulty sleeping. Sometimes I fall asleep and sometimes I don’t but I always feel great the next day. (Tip; get some of those ear buds that sports people use so they don’t fall out.)

Most of the techniques that help you get to sleep involve some kind of mindfulness, or some kind of activity designed to distract your mind from your everyday concerns (like counting sheep). Here’s just a couple of my favourites:

4 – 7 – 8 Breathing

Alternate nostril breathing

These are both beautiful yoga breathing exercises that help me to calm anxiety and relax my body. I’ve done both from the comfort of my bed.

It might seem strange, but I also find that doing pelvic floor exercises and counting them backwards from 1,000 helps. This is a simple activity to distract my mind and hey, who doesn’t need to do more pelvic floor exercises!

There’s a very popular yoga relaxation technique where you clench and then relax each part of your body, starting with your feet and moving to your calves, knees, thighs and so on, all the way to the top of your head.

If that’s all a bit much then just a simple meditation on the breath can help to get you ready for sleep. You don’t try to force your breath at all. You just observe it. Count as you breathe in and count as you breathe out. Now gradually start to increase you exhale by one or two counts.

My final tip is that if you’ve tried everything and sleep just isn’t happening then you’re better off getting up and having a glass of milk than staying in bed and fretting about it. Don’t reach for any electronic devices. Just have a drink of milk and then head back to bed and start again. If you can’t sleep, try to rest and relax rather than fretting over your lack of sleep.

Most importantly of all, remember that sleep is the great healer so if you’re finding you need more of it than usual during treatment or recovery just go with it. When I was having chemo I was sleeping up to 14 hours a day. During radiation treatment it was about ten hours a day. I’m now back to around eight or nine hours every night. Healing bodies need much more sleep, so snuggle up and don’t feel guilty about it.

Chemo Brain And How To Treat It

My brain is back.

It’s like the sun coming out after a week of rain. Except it’s been raining for over two years. The return of my full cognitive function hasn’t been as sudden as a change in the weather, but the impact on my mood has been as dramatic.

It’s like discovering I’ve been living in just one room and that my home has three storeys. It’s like discovering I’ve been driving around in first gear and my car has five gears. With hindsight, I realise how badly my cognitive functioning was effected by treatment, although living through it I probably wasn’t cognisant of how impaired I really was (and this might be one of the few benefits of chemo brain).

I know this condition has a huge impact on the quality of life of so many survivors, so I thought I’d share my best advice for recovery.

First of all, understand that as far as researchers have been able to determine, it’s not exclusively caused by chemotherapy. While we all call it ‘chemo brain’ or ‘chemo fog’ the correct description is ‘mild cognitive impairment following cancer treatment’.

The causes haven’t been clearly identified but it’s a real condition, and it can be picked up with imaging technology. In one study, breast cancer survivors not only required a larger area of their brain to respond to a question, they used more energy to do so. In another, the resting metabolic rate of the brain was slower.

So the first bit of good news is you’re not imagining things. That inability to remember your phone number, the name on the tip of your tongue or the misspoken phrase are all manifestations of ‘chemo brain’. So is a general feeling of fogginess, mental sluggishness and difficulty learning anything new.

Coping with it usually involves implementing the kind of strategies they give people with early dementia; keep lists; use a calendar and a notebook; have one spot where you always put the things you lose regularly. All of this helps but what we really want is an effective way to hasten our recovery.

The really good news is that recovery is not only possible, most people find it relatively easy to achieve.

Apart from physical damage caused by treatment, chemo brain might also be caused by a range of other factors. The main suspect is anxiety, which can cause cognitive impairment all on its own. Hands up anyone that managed to get through cancer without feeling anxious. Depression is also a common after effect of treatment and yes, it’s also characterised by brain fog. If you suspect you’ve got ongoing issues with either anxiety or depression it’s important to discuss this with your doctor.

Vitamin D deficiency could also play a part because most of us had to avoid the sunshine for several months due to either chemotherapy or radiation. If you didn’t take your vitamin D supplements and treatment just got you out of the habit of sitting in the sun then an improvement could be as close as eating breakfast outside every day. Special note here to avoid supplements with calcium in them because they’ve been shown to be a health risk and to favour sun over supplements when you can because the type of vitamin D your body manufactures in response to sunlight is more beneficial.

If you’re experiencing serious mental impairment it’s also worth asking your doctor to give you a simple cognitive test to rule out dementia or any other illness that might be impacting your cognitive function. Don’t just assume it’s a result of treatment.

Having discussed chemo brain with a number of survivors there’s now been several that have overcome their problems by dealing with anxiety, depression or vitamin D deficiency so consider those first. Once you’ve ruled out other causes there’s still plenty you can do to reclaim your brain.

Here’s my top six recommendations for treating chemo brain. Many of these are things we should all be doing to improve our health and boost our immune system so adding them into your daily routine should bring a whole lot of benefits.

Please treat this list as a menu rather than a prescription. Choose what appeals to you and try it for a few months before you rule it out. And please share any other ideas you have about this condition.

  1. Fasting (aka The Fast Diet or 5:2 calorie restricted eating)
    What it is: an eating strategy where you limit your calories to 500 on two days each week.
    Why it might help: Fasting triggers autophagy, the body’s natural mechanism for cleaning up dead and damaged cells. Even people that haven’t been through cancer treatment regularly report improved mental clarity when they adopt this way of eating.
    My experience: My cognitive function had been improving over time since I finished treatment but my biggest step forward coincided with switching to this way of eating. Of course it’s possible that this shift was coincidental so I’d be very interested to hear from anyone else that tries 5:2 or some other fasting regime and notices a brain boost. There are lots of good reasons for cancer survivors to consider fasting in any case.
  2. Yoga (Seriously, what isn’t yoga good for?)
    What it is: an ancient practice that links physical exercise with breathing and mindfulness
    Why it might help: Research shows that yoga has a profound effect on our physiology, including our cognitive function and our ability to deal with anxiety. Some of the benefits are undoubtedly associated with the increase of oxygen to the brain but yoga has such significant benefits over other forms of exercise that it’s clear they’re only scratching the surface of what’s going on inside us when we practice it.
    My experience: I’ve written before about the profound impact yoga has had on my ability to deal with treatment and my recovery. The benefits have ranged from helping me to deal with anxiety and pain to preventing nausea. Yoga helped me to restore my energy when treatment drained it and played a big part in my recovery from surgery thanks to my physical strength and flexibility.
    If you don’t find yoga appealing then exercise will also help you to recover your brain. I just don’t think it will achieve this as quickly or as well as yoga.
  3. Mindfulness
    What it is: a practice of focusing on the present moment and doing one thing at a time. Some people use meditation to learn mindfulness and others learn it by just focusing on whatever they are doing right now.
    I use both. Mindfulness for me includes listening to recorded meditations on my iPod and paying close attention to whatever I’m doing during the day. Even the washing up can be a meditation.
    Why it might help: Mindfulness trains your brain to still the ‘monkey mind’ that jumps from one thing to another. It also helps to reduce anxiety which might be a major contributor to cognitive impairment.
    My experience: Mindfulness has helped me to stay calm and to be present. My mind functions better when it’s calm.
  4. What you put in your mouth
    What it is: Attention to good nutrition, good hydration and avoiding those things you know aren’t good for you.
    Why it might help: Food and water are fuel for our bodies and the functioning of our bodies is directly linked to the quality of that fuel. We know that children show huge cognitive improvement when their diet is improved and that it also has an impact on mood and behaviour. Recent research into the addition of fresh vegetables into the diets of older people also demonstrated improved cognitive function. We are what we eat.Water is also critical to healthy brains. I noticed in hospital that my low blood pressure was immediately remedied by drinking a glass of water and our brains rely upon a good blood supply to function.

    Avoiding those things we know are unhealthy, including alcohol, highly processed food and high sugar food will also have an impact on our brains. People with allergies and food sensitivities will know that a small change in diet can mean a big improvement in health.

    My experience: My diet was pretty good before I was diagnosed. It’s even better now. I’ve significantly reduced all of those things I know are unhealthy while still allowing for the occasional treat. We predominantly eat organic food and I cook from scratch. I’ve cut right back on gluten after I noticed (thanks to The Fast Diet) that it made me tired and bloated. I still need to work on drinking enough water every day but I’ve improved on that score too. It comes as no surprise to me that the better I eat, the better I feel.

  5. Iodine Supplements
    Regular followers will know that I’d rather get my nutrition from food than supplements but based on my own research and an examination of my diet I determined that there was a possibility that I was iodine deficient. I don’t eat a lot of fish and while dairy used to be a good source of iodine, changes in farming practices mean it’s no longer used. The clearing of the fog has coincided with the introduction of iodine into my diet so it’s worth considering. Please let me know if you have similar results. As always, I strongly recommend you discuss any supplementation with your medical team, particularly if you’re in active treatment.
  6. Sleep
    Sleep is the great healer. When I was in treatment it was common for me to sleep in excess of ten hours a day. As my health has improved my need for sleep has declined but I still regularly get eight hours. Sleep is such an important part of recovery that I’m dedicating all of my next blog post to it.

Here are some other things you might like to try:

  1. Learning a language or a musical instrument
    If you’ve read any of the recent research into neural plasticity you’ll already know about this one. It’s long been thought that the only time when the brain was ‘plastic’ and able to create new neural pathways was during early childhood. Now it’s clear that we can keep building new connections in our brain for the whole of our lives. The quickest and most effective way to do this is to learn something new. Languages and music are particularly good, but learning anything new will help. A number of people have told me they’re finding ‘luminosity’ (a web site that charges you a monthly fee to play ‘brain training’ games) very helpful. You could also try puzzle books or free online puzzle sites.
  2. Get creative
    Creative pursuits are good for your brain and your mood. Pick something you really enjoy and dedicate a bit more time to it. It might be gardening or scrapbooking or making furniture out of scrap wood. It really doesn’t matter what you choose as long as it gets you making lots of happy choices. There’s a huge surge in the popularity of colouring in books for adults at the moment. I wish these had been around when I had chemo. They’re very relaxing and great fun, combining creativity with mindfulness.
  3. Take a holiday
    A break from your usual routine can be good for your brain. It doesn’t need to be expensive or involve air travel. It might just be a weekend visiting a good friend. The aim here is to find something restful and calming. If the thought of packing a bag and going anywhere makes you anxious then stay home.
  4. Have a cuddle
    Not that anyone needs an excuse, but cuddles are good for your brain. They increase oxytocin levels and this helps you to feel calmer and happier. You can cuddle a person or a pet. You can cuddle a partner a friend or a child.
  5. Have a massage
    It’s a combination of cuddling, mindfulness and increasing oxygenation. It’s the triple whammy of treatments when it comes to helping you restore cognitive function. You can also credit it with reducing anxiety, giving you a break from your routine and helping you to feel good about your body. There are now massage therapists that specialise in treating people going through or recovering from cancer treatment, so look up ‘oncology massage’ and treat this as a necessary part of your recovery (rather than an occasional treat).

Finally, don’t give up. There’s no upper limit to how well we can be. Recovery from chemo brain is certainly possible and most of the things that help us to achieve it are things we should probably be doing anyway.

Spare Me The Doom and Gloom

This morning a friend posted a great article about researchers finding a new biomarker for triple negative breast cancer. Like all reports of research breakthroughs, this is happy news. Each day we’re closer to a cure. Here’s a link:

http://www.medicalnewstoday.com/articles/297646.php

This is another step forward but I also note that this article opens with the paragraph we see all the time. It’s this, or a version of it:

‘Triple-negative breast cancer is one of the most aggressive types of breast cancer. It has few treatment options, making the prognosis poor for affected women.’

Actually, in many cases it responds well to chemotherapy, surgery and radiation (excuse me, but aren’t they ‘treatment options’) and the average five year survival odds are 75%, which is SO much better than many other types of cancer, such as melanoma or lung cancer.

I can appreciate that there’s a couple of things going on here. Firstly, researchers keen to attract funding are sensibly using emotive language to generate interest. Secondly, journalists are after an attention grabbing headline. The use of this language to describe triple negative breast cancer is now so prevalent that you’ll find it at the start of almost any article on the subject.

So let’s take a look at the facts.

The ‘more aggressive’ description is accurate. It’s also the reason that many of these cancers respond so well to chemotherapy. It’s now common for triple negative patients to be offered chemotherapy before surgery. There are several benefits to this approach. ‘Triple negative’ is a description of a group of cancers rather than a single cancer. What they have in common is the absence of the three known receptors, oestrogen, progesterone and HER2. But research is already starting to tease this single category out into several sub-categories.

This matters because what works on one person’s triple negative breast cancer might not work on another. Having chemotherapy first allows doctors to see whether or not a particular cancer is going to respond to chemotherapy.

Having chemotherapy first is not usually an option for slower growing breast cancers. Triple negative, on the other hand, achieves a pathologically complete response in around 40% of cases (and this continues to improve with newer treatments). That means your tumours are completely wiped out by chemotherapy.

Even in cases where there’s only a partial response there’s evidence of improved survival rates. In my case, three of my four tumours were gone by the time I finished chemotherapy. So when I read ‘few treatment options’ I get a little annoyed at the doom and gloom. Recently diagnosed people read this stuff and panic. I know I did.

Yes, these cancers are more aggressive, but when it comes to chemotherapy that’s actually an advantage.

There are no ongoing adjuvant treatments for triple negative breast cancer. Those with other types of breast cancer are offered medication that significantly reduces the risk of recurrence. These treatments have been so effective that the five year survival statistics for other forms of breast cancer come in around 86%. These figures improve every year as the impact of new and better treatments affects the statistics.

Remember, you can’t quote five year statistics until you’ve waited five years. What this means is that today’s numbers are already five years old. The other important thing to remember is that the only reason they stop collecting data after five years is because it becomes costly and more complicated. The older we get the more likely we are to die of anything at all. I’ve met people who think that the five year cut off means they are not likely to be here in five years so this is an important one to understand. It’s just the end of the data collection and has no impact on your survival.

If you’d been diagnosed with a hormone receptor positive cancer (oestrogen or progesterone) or a human growth factor positive cancer (HER2) then you would be offered one of the newer medications. These include hormonal therapies, such as tamoxifen or aromatase inhibitors, or treatments that target HER2 receptors, including trastuzumab.

There’s currently research into whether or not tamoxifen might be effective on triple negative, but otherwise these medications are not available to those diagnosed with this group of breast cancers.

This appears to be the reason for the description ‘few treatment options’ but it would be more accurate to say ‘Triple negative breast cancer often responds well to chemotherapy, surgery and radiation but there are currently no available drug therapies that improve long term survival, as there are for other cancers.’

The ‘poor prognosis’ tag reflects the lower five year survival rate but I think calling 75% ‘poor’ is a bit of a reach. If you had three chances in four of winning the lottery, wouldn’t you want a ticket? That’s what 75% means. Until the last two decades or so, a triple negative diagnosis was a virtual death sentence. In that very short time our odds have improved significantly.

Five years is also a point where one of the advantages of triple negative breast cancer kicks in. Having survived for five years we are much less likely to experience recurrence than other types of breast cancer. This is very good news.

I’ve made this point about statistics before but I think it’s worth restating. Statistics are about averages across an entire population. I am not a statistic. You are not a statistic. Every single thing you can do to improve your health and wellbeing improves your personal survival chances.

And that brings me to my biggest issue with this type of headline. Having recently seen the movie The Connection: Mind Your Body, I am convinced of the significance of a whole range of ‘mind-body’ approaches when it comes to living well after cancer. Yoga, meditation, reducing stress, mindfulness and a range of associated complimentary treatments are now proven methods for boosting our recovery and maintaining our good health.

Headlines that tell us we’re facing a ‘poor prognosis’ from an ‘aggressive cancer’ with ‘few treatment options’ have the potential to undermine our treatment and our recovery. Accuracy about the facts is not just about good journalism, it’s also about giving patients something that potentially contributes just as much to our well-being as any new wonder drug.

Hope.

Negotiating the Anxiety Tunnel

Having recently experienced the anxiety that comes with discovering a lump, waiting for a doctor’s appointment with a long weekend in between and then waiting for tests and results I’m now reflecting on what I call ‘the anxiety tunnel’.

Anyone whose ever faced a cancer diagnosis will be familiar with the tunnel. We travel through it when we’re first diagnosed and don’t know what that diagnosis will mean. We head back into it when we’re waiting for the results of biopsies, or pathology after surgery. Sadly, some people find themselves feeling like the tunnel is their new permanent residence, as anxiety about recurrence becomes a regular shadow over their lives.

I had a message recently from a regular reader of this blog. She wanted to know how I deal with the anxiety. She tells me that her distress in similar situations is so overwhelming that she’s desperate for any advice that might help. So here are my top ten tips for negotiating the anxiety tunnel:

1. Treat It Like The Flu
You know how when you have the flu you just expect to not be your best? I find it helps to have the same attitude to anxiety. I think of it as ‘anxiety flu’. I accept that until I get my results or reach the end point of my uncertainty, I’m just not going to feel my best. This is normal. I am not ‘going crazy’. Adjust your expectations of yourself for the next few days. You’re not going to be firing on all cylinders. What can you delegate? What can you postpone? What can you ignore? Like any bout of illness it’s also worth paying attention to what you put in your body. It’s okay to eat less if you’re not hungry. Drink plenty of water so you don’t dehydrate and try to make sure that what you do eat is nourishing.

2. Breathe
One of the first physical changes that most of us experience with anxiety is a tendency to hold our breath or to breathe quickly and into the top of our lungs. Sit quietly. Put one hand on your heart and one on your belly. Breathe deeply and slowly into your belly and feel it expand. Try to make your exhale longer than your inhale. Hold yourself gently, the way you’d hold a baby or a cuddly animal. Close your eyes if that helps. Just sitting like this for a few minutes can calm your nervous system.

3. Ask For Help
Our friends and family really love feeling useful. Let people know what they can do to help. You might have practical tasks that need doing. You might feel too anxious to drive and need a lift somewhere. You might need help with some of the other things on this list. Ask.

4. Repeat After Me
In the Hindu tradition, a mantra is a phrase or group of sounds with spiritual significance. Practitioners believe that by reciting a mantra you can bring about physical and spiritual changes in the body and in the world around you. You don’t need to be Hindu, or even spiritual, to try this technique. Essentially you either recite a phrase out loud or to yourself, repeating it until you feel more peaceful. The simplest mantra is ‘Om’ or ‘Oum’ and I do find that singing this out loud is very calming. I also have some favourite phrases that I repeat to myself. You can use any of these or come up with some of your own:
* This too shall pass
* It is what it is
* Let it go
* Where there is life there is hope
* You’re not dead yet!
Some people find the last one a bit macabre but I’ve found it useful to jolt me out of my downward spiral into imagining my own funeral.

5. Play Some Music
We all know music can have a profound effect on our emotions. I’ve put together a collection of music that either helps me to relax or lifts my mood and I use it to ease my passage through the anxiety tunnel. I like ‘Sacred Earth’ with their kirtan inspired repertoire for relaxation, along with just about anything composed to accompany yoga. To lift my spirits I’ve got songs I like to listen to or sing, particularly “I will survive”.

6. Exercise
Anxiety means your body gets flooded with adrenaline and cortisol. It’s these hormones that give you the jitters and keep you awake at night. Exercise is a great way to help your body process these chemicals and return to normal. A caution here; ‘boot camp’ styles of exercise (including those where your internal talk sounds like a boot camp instructor) will make things worse because they generate more adrenaline and cortisol. You need exercise that is a combination of strenuous and relaxing. Try a brisk walk in a beautiful location, riding a bike, dancing to music, yoga or lifting weights that are well within your capacity. If you’re a gym member and your local gym has a power plate (a vibrating thing that you stand on) these are reputed to help your body reduce cortisol. Worth a try.

7. If You’re Feeling Crabby, Get to Water
Warm baths, warm showers, a swim in the ocean on a hot day, a hot tub or spa bath, all of these have the potential to help you relax when you’re feeling crabby. If the weather is warm enough, one of my favourites is to float on my back in a pool and look at the sky. I remember that my mind is like the sky and my thoughts are like the clouds. They will pass.

8. Meditation and Mindfulness
It’s possibly the most common prescription for anxiety and the one least taken. It think that’s because even sitting still is difficult when we’re in the tunnel. Our minds are so noisy and busy that even the suggestion of meditation seems laughable. Of course, the times we most need meditation are the times when it seems the hardest to achieve! I’ve found some recordings that I really like and when I’m feeling anxious I know these will help. I’ll admit that I’m sometimes on day three or four of my anxiety before I reluctantly admit to myself that it’s about time I stuck the headphones in my ears. Even if you don’t feel like meditation you might like to try mindfulness. This is simply the act of being present, or paying attention to what’s right in front of you and living in the moment rather than worrying about the future or the past. There’s a lot of great mindfulness and meditation resources on the net. Just google to find something that suits you.

9. Decide How Busy You Want To Be
Some people negotiate the tunnel best when they are alone, or just in the company of a few chosen companions. Others are best distracted by company or activities. Which are you? It’s good to have a clear idea of how busy you want to be before you enter the tunnel. If you know you’re better off alone then clear the decks, batten down the hatches and give yourself permission to nest. If you need to be occupied then think about what kind of activities will help. Most recently I happened to find lumps just before a long weekend with two big gatherings scheduled. Both were a welcome distraction. Some people follow the ‘laughter is the best medicine’ recommendation and break out comedy DVDs or even children’s movies. If you’ve never seen ‘The Leggo Movie’ I highly recommend it. The big message here is that it’s okay to put yourself first in this situation, regardless of your prior obligations or anyone’s expectations. People will understand.

10. Contact
It’s usually when my husband opens his arms and says “come here” that I remember the profound effect that physical contact can have on anxiety. Just having someone hold you for a while can make a world of difference. When I’m anxious I appreciate all the contact I can get. I’ll sometimes pay for a massage or ask a friend for a hug. Even having someone hold my hands helps. Physical connection helps us feel safe and cherished. I think of all my strategies for dealing with anxiety, this one is the most effective.

A Warning About Flow
I’ve seen a lot of articles that recommend using whatever it is that puts you into ‘flow’ for dealing with anxiety. For those unfamiliar with the concept, flow is that experience of enjoying something so much that time just seems to fly by; you are so engrossed in the activity that it captures your full attention. Essentially this is another version of mindfulness. My concern is that if you attempt a favourite activity while you’re anxious there’s the potential for stress to suck the joy out of it. I love gardening. Sometimes when I’m anxious, being in the garden is a great way to anchor myself in the present and occupy my mind. Other times it’s a half-hearted distraction that adds to my anxiety as I find myself making obvious mistakes or becoming submerged in my own thoughts. If you find that a favourite ‘flow’ activity helps you to achieve mindfulness then that’s a great strategy, but be prepared to abandon it and try something else if it’s just making you more anxious.

So that’s my top ten.

Please consider it a menu rather than a prescription.

These are the things I find useful but they might not appeal to you. I’d encourage you to try some of them, even if they feel a bit awkward or odd. Reading about dealing with anxiety is a bit like reading about riding a bike. You’re not going to achieve anything until you actually have a go.

You might feel a bit challenged and out of balance at first but with patience and practice you’ll probably find that things get easier. I’d also encourage anyone that’s feeling overwhelmed by anxiety to seek the support of a professional psychologist or counsellor, particularly one with training in Acceptance Commitment Therapy (ACT).

You do not need to spend the rest of your life living in the anxiety tunnel. It is possible to return to having a happy and rewarding life.

If you can’t afford to pay for a therapist then contact cancer support organisations in your area or google phone and online support services. One of the positives of dealing with cancer is that there’s a lot of great support out there.

There is light at the end of the tunnel.

Eagles

I decided to be an eagle when I was thirteen years old.

I grew up in a home surrounded by books. We read a lot of fantasy and science fiction. I loved stories about people that could transform themselves into animals, or inhabit the minds of animals. I also loved cats. I spent most of my lunch breaks in the first year of high school in the library, taking advantage of an amazing piece of new technology called a photo copier. I used my pocket money to make grainy black and white images of every kind of cat.

I got a part time job working at a coffee shop in Terrigal. A lot of the customers were rich people on holidays. They were very rude. They wanted the cinnamon sugar all the way to the edges of the toast. They wanted the chocolate powder on top of the coffee but not on the saucer. My boss would say “Rise above it.”

I read two books, one after the other. The first was about totems and native americans and how they gained wisdom from their totem animal. The second was about an eagle, written from the eagle’s point of view. Until then, I’d always thought that if I could be any animal I would be a leopard or a tiger. I decided, secretly, that my totem was an eagle.

If I was bullied at school I would rise above it. I was very fair skinned with dark hair and glasses, living in a part of the world where everyone lived on the beach and had suntans and blonde hair. I didn’t know it at the time, but I was also nerdy. I wasn’t badly bullied but I was bullied. Instead of responding like a rabbit in the headlights of an oncoming car I would imagine myself flying, high above the school to an eerie where I could look back and realise how tiny and insignificant the humans were. I wore strange clothes with my school uniform (friends remember the splendid multicoloured crocheted poncho). My glasses meant that I needed to turn my head to see properly, like an eagle.

I dreamt of flying. I would wake up with stiff shoulders. I would lay on my stomach and imagine huge wings on my back.

As I grew older I became better and better at seeing the big picture. It became part of what made me a valuable employee. As a police officer I was the one that found missed details at crime scenes, asked left-of-centre questions in interviews and found strategic ways to build a brief of evidence. When I moved into management I was the kind of leader that valued everyone’s contribution, I understood systems and how they interacted. I understood leverage and how a small change in one area could result in big changes in another. I knew the difference between real change and the statistical blip that so often gets used to declare operational success. People said I often had ‘a helicopter perspective’. Really it was the eagle.

The analogy I see used most often to describe the way people feel when they’re given a cancer diagnosis is the rabbit one. We jump about. We freeze. Our inability to act in the face of danger places us in the path of an oncoming vehicle. We stare back at death. If we don’t mobilise we die.

I did this. It lasted a couple of days. Then I remembered the eagle.

Lift up. Rise above it. Get some perspective. See things for what they really are.

Sometimes this includes recognising how tiny and insignificant I am. A lot of people don’t understand this way of thinking. In a world where we’re all encouraged to see ourselves as the masters of the universe it seems to be counter-productive. I find it helpful to remember that my life, all our lives, are tiny drops in the ocean of human history. I also find it helps me to remember that just a few streets away, or just next door, there’s another person dealing with another crisis whose also feeling like their world is collapsing. When I take a wider view, there are thousands in this town, millions in this country, hundreds of millions of people all over the world, dealing with their own problems (and many of them are, surprisingly, much worse than a cancer diagnosis).

Sometimes, having and eagle’s perspective includes recognising how powerful I am. I can soar. I can pull up from the everyday and look back at it. I can give it context and broader meaning. I can rise above it.

The ability to worry, and to worry about the impact of our worrying, and to worry about that, seems to be a particularly human trait. I’m sure all animals get anxious when they’re under threat, but they respond. Fight or flight, not sitting about ruminating and becoming less and less able to deal with the situation. We often dig our own holes and then sit in the bottom of them, pulling dirt back into the hole and complaining about the mud.

I’ve done this too.

My father died of bladder cancer in his late 50’s. He had been a local politician, highly regarded by many for his dedication to helping people. Years later they named a bridge after him. On the day the bridge opened a huge eagle flew all the way down Brisbane Water and circled above the bridge. My mother said that the eagle was my father.

I’ve never told her about my totem.

I know that life is going to keep throwing up circumstances that feel like the headlights of an oncoming truck. Because that’s life. I also know I have a choice. I can be a rabbit or an eagle. I just have to remember that I have the choice. If I can remember to think of eagles, and to imagine I am one, I can fly.