How to Have a Really Happy New Year

It’s New Year’s Eve and friends are planning everything from full scale public events to quiet nights at home. We’re still not sure what we’re doing but the offer of something in between sounds appealing. A stroll to the waterfront to watch the local fireworks followed by a wander back to a nearby home for the Sydney edition on television.

I suppose at some point in the evening, whatever we decide to do, there will be inevitable question about New Year’s resolutions. I don’t usually make them. Research shows that they’re a waste of time and that most people have broken them before the end of January. It’s not that we don’t want to break bad habits, it’s just that it takes more than one commitment on one night every year to do it.

I’ve been thinking about successful alternatives to the resolution ritual. I like to pick a theme for the year. Last year (not surprisingly) I chose ‘health’ and I regularly revisited that goal, thinking about how I might incrementally improve on what I’d already done. This works well for me. It’s not a daily obsession. More a thread that runs through the year that I come back to on a regular basis.

My beautiful yoga teacher, Emma, held a class today and reminded all of us that in yoga, we make resolutions (or ‘set intentions’) every time we come on to the mat. Yoga also teaches that we should be kind to ourselves and to not push ourselves beyond our intelligent edge. That brought me all the way back to resolutions and the kinds of intentions that are usually behind them.

It seems to me that a lot of New Year’s resolutions are a mild form of self-bullying. We hunt for our deficiencies, give ourselves a good talking to and commit to doing better. No wonder we fail. Why does being healthy have to involve attempts to leverage guilt and shame? When did guilt and shame ever reliably motivate us to do anything?

What if, instead of beating ourselves up, we saw our new habits and practices as gifts we give ourselves.

The key for every new habit I’ve formed has been the joy it gives me. I love yoga, massage, my weekly gratitude posts, my connection to what I value and my commitment to building on my strengths rather than focusing on my weaknesses.

I am human and therefore fallible. I don’t always eat as much salad as I would like to, and I sometimes have too much refined or processed food although to be honest, this happens less and less as I become more aware of how unwell it makes me feel, but you see, that’s the critical difference. I’m not carrying around a list of things I’m ‘not allowed’ and calling myself a failure if I eat them. I could eat anything. I choose to eat well most of the time.

I’ve even come to enjoy my two fast days every week. Seems crazy, I know, but I enjoy a whole day without cooking and cleaning up afterwards and I love that I’m doing something proactive to prevent cancer from ever coming back.

It’s the same with exercise, drinking much less, building good relationships with friends and family, forgiving those that have upset me, doing all of the little things that add up to a joyful and happy life for me. I choose them.

I choose them because it took cancer for me to really understand that I am limited, time is limited and this is the only body I will ever have. (Thanks again, cancer). It also took cancer for me to understand that the greatest gift I can give to the people that love me is to take action that contributes to my health and happiness.

And that’s all I want from them too. I want them to joyfully make choices that help them to have a healthier life. To give themselves the gift of good health.

It’s also what I wish for all of you.

Thank you to all of you for continuing to read and share my blog. I got an annual report from WordPress telling me that enough people visited my blog this year to fill three concert halls. That’s amazing! It’s also very humbling.

So here’s my wish for everyone this New Year; please consider dispensing with the resolutions and deciding what gifts you might give yourself. You deserve to be healthy. Please shift your focus to being healthier and happier all through 2016 and leave the resolutions alone.

Happy New Year.

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.

One Year Post Mastectomy

Fanfare please!

It’s been one year since my bilateral mastectomy.

It seems like an appropriate time to post an update on my recovery and to reflect on what’s helped, what’s hindered and what needs to happen during the next year.

There will be photos, so if you’re squeamish about scars then best skip this one.

The short version; I feel great. Lately I’ve actually been feeling well, really well, for the first time since my surgery. I’m amazed by the body’s ability to heal and surprised at how long it’s taking.

If you’d asked me just after surgery how long I thought my recovery would take I would have guessed three months or so. Even one whole year later there’s still a little way to go before my body is done.

This is important.

There have been times during the last year when I’ve thought, ‘Is this as good as it gets?’ It seems to me that healing will happen for a while and then there will be a plateau where nothing much changes. I’ve come to think of these plateaus as the body taking a rest from the hard work of healing.

The whole experience has been an opportunity for me to take a hard look at my life and my habits. I suspect there are people whose recovery is passive. They wait and hope, trusting that whatever medical treatment they received will do all the work for them.

It’s been my long experience that recovery from anything needs to be active. We can support or hinder our recovery with some very simple choices, like what we put in our bodies, how much sleep we get and how much stress we’re prepared to tolerate.

I’ve been actively participating in my recovery.

I’ve cared for my skin, particularly the site of my surgery, by using a body oil after my shower. I’ve also taken care of lymphatic drainage from my left side by using gentle massage throughout the day. This area has had a lot of damage following three surgeries and radiation. While I haven’t had any signs of lymphodema, I see regular lymph drainage as an important preventative measure. I’ll be doing this for the rest of my life.

I’ve lost weight using The Fast Diet. My doctor recommended this because there are statistics showing that excess weight can contribute to breast cancer risk. Fasting also triggers autophagy, the body’s natural mechanism for cleaning up dead and damaged cells. Anyone whose experienced triple negative breast cancer knows that we don’t have any of the new ‘wonder drugs’ available to us. Fasting seems like the best thing I can do to prevent recurrence. I’ll be doing this for the rest of my life.

Yoga has probably made the single greatest contribution to my recovery. I do at least one class a week (two when my husband joins me) and I practice at home every day. When I wake up in the morning I get dressed in my yoga gear. I have coffee and check my messages and daily schedule and then it’s straight into yoga before breakfast. I’m able to do things with my body that I couldn’t do before I was diagnosed. Of course the point of yoga is not to twist your body into increasingly difficult poses. Yoga is about integrating the mind, the body, the spirit and the breath. Yoga has helped me to love my post-cancer body and to feel strong and flexible, mentally and physically. I’ll be doing this for the rest of my life.

Massage has also been a big part of my recovery. I found a local massage therapist with specialist oncology training. As well as regularly helping me to move back into my own body she’s gently massaged my surgery site and this has greatly assisted in settling all of the nerve pain and helping me to regain sensation in that part of my body. It’s also deeply relaxing.

I was eating fairly well before diagnosis and treatment has been an opportunity to review what goes on my plate. We’re shifting towards more and more vegetarian meals. I rarely eat gluten any more and I feel better for it. I’m naturally eating less food thanks to The Fast Diet and the impact on my appetite. We’ve adopted the SLOW principles as much as possible; Seasonal, Local, Organic, Wholefoods.

I’m eating much less sugar and finding that I can’t eat anything really sweet anymore. I suspect this is because fasting has killed off the gut bacteria that trick my brain into wanting more sugar. The recent discoveries in relation to the gut biome continue to fascinate me. I’m sure we’re only just beginning to understand how important this work is for our future health. It’s certainly a strong motivator to avoid processed foods with all their additives and preservatives that prevent bacterial growth.

Thanks to a couple of visits with a psychologist with ACT (Acceptance Commitment Therapy) training and Russ Harris’s books on the subject, I’m now very clear about what’s important to me, what I value and what I want my life to stand for. To celebrate my one year anniversary I’ve enrolled in a permaculture course. There are those that would argue I don’t need this training because I’ve been practicing permaculture all of my adult life.

My friend Cecilia challenged me to ‘become a world famous permaculture teacher’ which is what motivated me to finally enrol. She’s clever. I don’t really need to become famous (nor do I want to) but I really do want to teach the skills I’ve been practicing for so many years. Permaculture is simply the best way to be human and the map for the survival of our species.

One of my favourite quotes has always been ‘Be the change you want in the world’. When I was a teenager I looked at a photograph of the planet from space showing all of the lights of civilisation and spontaneously thought ‘human cancer’. I was distressed by the damage we were doing to the planet and a sense of helplessness. For me, permaculture holds the key to healing humanity’s cancerous impact on the planet. It’s probably going to keep me well too.

So here’s my latest photos.

As you can see, I’ve come a long way since surgery.

P1070559 P1070558 P1070557 P1070556

 

 

My chest has gone from being almost completely numb to almost completely recovering sensation. I still have numbness along the scar lines and there’s an area of nerve damage above my original surgery scar (that’s the little arc high on my left side). Nerve damage feels like electricity under the skin. It’s continued to improve with massage and I’m hopeful that it will eventually disappear.

My chest still feels a little tight, as if I’ve got a large sticking plaster on it, but this has improved and I believe it will also vanish in time. For most of last year I felt like I was wearing an undersized bra (how ironic) and the tightness extended all the way across my back. That’s resolved now and I only have my chest to deal with. Yoga and massage both help with this.

I still need to remember to keep my shoulders back and to hold my body up. My doctor tells me it’s common for mastectomy patients to develop a stooped back and rounded shoulders. I suspect this is a combination of relieving that sensation of tightness and, perhaps, embarrassment at having no breasts. I regularly roll my shoulders up and back, particularly when I’m at the computer.

My neck has taken a while to adjust to the absence of two F cup breasts. Removing close to two kilos of weight left my neck and shoulders in a state of shock and once again, yoga and massage have helped. A friend showed me this neat trick; point your index finger at the sky; now bring your finger so it touches your chin and the tip of your nose; push back until you feel your neck is back in alignment. You can also push your head back firmly into a pillow when you’re in bed, or the head rest when you’re in a car. This simple exercise has had more impact on my neck pain than anything else.

As for the other side effects from treatment, I’ve also seen big improvement. I rarely experience any peripheral neuropathy in my feet. I still wake with sore hands but they warm up quickly. I need to be careful with any activity where I hold my hand in the same position for any length of time, such as drawing or sewing. My hands tends to cramp up and become painful. I haven’t given up on my body’s ability to regrow nerves. While one doctor told me I’d probably be stuck with whatever I had at twelve months post chemo, another said it can take six years for nerves to regrow. I’ve already had improvement since my twelve month mark so I’m going with option B.

I have a mild hum in my ears. This is probably also chemo related nerve damage but it could just be age. My Mum has age related hearing loss. It’s important to remember that not everything going on with our bodies is related to treatment. I don’t have that awful metallic taste in my mouth any more and I think this is also a form of peripheral neuropathy. Food tastes wonderful again, particularly straight after fasting.

I wonder to what extent the fasting has promoted healing. The science indicates that it should make a difference. In early days, I certainly noticed more rapid healing following a fast. I’ve observed that if I have any kind of skin blemish it’s usually completely healed after fast day.

As you can see from the photos, the radiation damage to my skin has greatly improved. As well as the circulatory benefits of massage, I think the regular application of rose hip oil has made a huge difference.

As you’ve probably already guessed, my mental state is great. People recovering from mastectomy are, not surprisingly, at high risk of depression. I’m very grateful that the care I’ve received and the work that I’ve done have helped me to avoid that particular complication. In many ways, depression is a worse disease than cancer and certainly at least as deadly. I think avoiding depression has involved a combination of things but particularly the information about ACT, practicing ACT and the benefits of yoga.

The most significant contribution to my state of mind has been the love and support I’ve received from so many people. Special mention must go to my beautiful husband who has continued to love and cherish me through all of this. I’m still beautiful to him. It’s an enormous advantage to have someone like that in my life and I grieve for those women that go through this on their own, or whose partners leave them during treatment.

I no longer experience ‘chemo brain’. I feel as mentally alert as I ever did. I’m also calmer, happier and less stressed than at any other time in my life.

I’m now taking stock and asking ‘What else can I do to continue with my recovery and to improve my health?’ I’ll also be doing this for the rest of my life. I believe that there is no upper limit to how well I can be. To put it another way, no matter how well recovered our bodies seems to be, there is always more we can do to improve our health.

Thanks to everyone that’s been following the blog and the accompanying Facebook page. Special thanks to those that have taken the time to let me know that something they’ve read has helped them with their own recovery. You’re the reason I keep writing.

Go well. Live well. My best wishes for your continuing recovery.

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.

Six Months Post Mastectomy

WARNING: This post contains photos of my mastectomy scars. Skip this one if you’re likely to find that upsetting.

It’s the eighth of February today. That’s six months since my mastectomy.

Anniversaries take on a new significance when you’ve had triple negative breast cancer because our highest risk of recurrence is within the first three years. By the end of five years our risk has dropped to the same as everyone that’s never had breast cancer. It’s one of the few consolations for having a form of breast cancer that’s typically described as ‘more aggressive and with a worse prognosis than other breast cancers’.

I thought you might like to know how I’m travelling.

In a word, brilliantly!

My wounds are almost (but not quite) fully healed. I’ve been surprised by how long it takes. There’s a period of rapid healing immediately after surgery, as I expected, but then there is also a long, slow healing where the scar tissue gradually loosens up and improves in both appearance and sensitivity.

I still get strange electrical pings from time to time, but nowhere near as often as I used to. The tightness around my chest had greatly improved, particularly across my back. Following surgery I had a strange stabbing pain in the centre of my back when my bra fastening used to be. If I rolled my shoulders forward it was worse. That’s completely gone now. So is the mysterious stabbing pain on the outside of my upper arm near the shoulder. My surgeon, Kylie, described both as ‘referred pain’ and I’m happy to be over it.

How to describe the sensation across my chest? I think if you took something like a clay mask,  spread it over your chest and let it dry you’d be approximating the sensation. It’s a little tight, but not painful. Kylie warned me that my chest would get tighter over time and then it would ease. I’m at the happy end of the easing process with hopefully a little way to go.

As the skin has loosened away from the muscle it’s become more comfortable. You can see from the photos that there’s now a little bit of a droopy bit, particularly on the right hand side. I joke with my husband that my breasts are growing back. Actually, it’s a good thing because I now look less like a mastectomy patient and more like a naturally flat chested woman. I’m doing some hand weights to build up my pectoral muscles and to give me a bit more of a natural shape.

Having said that, I’m now completely comfortable with my flat chest. I’ve had a lot of fun replacing most of my old wardrobe. My two favourite ‘looks’ are a beautifully patterned cotton shirt over a singlet with long pants, or one of those box shaped dresses that sits just above the knee. I didn’t feel comfortable wearing shorter skirts before my surgery but now I enjoy putting my ‘yoga legs’ (as Graham calls them) on display. I’m accessorising with beautiful scarves and long necklaces which now sit beautifully thanks to my dolphin chest.

The only pain I have is from arthritis in my hips and shoulders (which I would have had anyway) and the peripheral neuropathy in my hands. They are very sore when I first wake up but improve quickly with my morning yoga.

My recent followup appointment was with my radiation oncologist, Andrew. He reminded me that I shouldn’t give up on the peripheral neuropathy and that sometimes nerves take a very long time to regrow. He suggests waiting a decade before calling it quits. This is great news because Rachel, my oncologist, has warned me that whatever I had twelve months after chemotherapy I would probably be stuck with for the rest of my life. It’s not really a big deal either way. I can still type, obviously, and last week I finally returned to playing my cello.

It’s made me very happy to discover that in spite of the numbness in my fingers, the need to completely reposition my instrument and the poor playing that results from two years without practice, I can still read music and make a beautiful sound. The challenge now is to return to daily practice. Like so many things, the cello requires a regular small investment in order to reap returns.

Andrew and Rachel are in agreement about what we thought was recurrence. It’s likely that this was actually DCIS left behind after the first surgery rather than new cancer. Why does this matter? Well, there’s a huge difference between a bit of old cancer still growing away and a whole new outbreak of the disease, particularly in terms of my long term survival odds. Although I was initially shocked at the possibility that my surgeon had made a mistake I now consider it to be serendipity, a happy accident.

You see, what we know, thanks to Kylie’s ‘mistake’, is that the cancer I used to have was resistant to chemotherapy and radiation therapy. It is almost certain that I would have needed a mastectomy at some point. Having it when I did meant the tissue removed was free of cancer and that greatly contributes to my future survival. You don’t get better margins than ‘no sign of cancer in this tissue’. If Kylie had removed a bit more tissue in the first surgery I would still have potentially lethal breasts with no guarantee that we would have caught the recurrence before it had spread to vital organs. Everything has turned out for the best.

I know Kylie still beats herself up over leaving the clip and some of the tumour bed behind. I’m glad I’m not a doctor. They are human like the rest of us and that means that, sooner or later, they will make a mistake. It’s unavoidable. A world where it’s safe for them to acknowledge that and talk about it is a safer one for all of us. It’s not a metaphor when people say that doctors often bury their mistakes!

It’s an interesting thing to come face to face with your own mortality. Last night I lay in bed thinking about a new blog called ‘We are all dying’ or ‘live like you’re dying’ because I now believe that when you really understand this, all the way to your temporary bones, life becomes richer, more precious, more meaningful………if you let it!

It still sneaks up on me at odd moments. My husband and I will be watching something on the television and laughing or joking about it. I’ll suddenly feel overwhelmed by my love for him and all he’s done and been since I was diagnosed. One day we will both be gone. That makes being here so much more beautiful.

When we’re intimate I sometimes weep with the wave of emotion that floods me. He touches these scars as if they were precious. You’ll notice that the photos are the right way around for this post because I finally felt okay about asking him to photograph them rather than using a mirror and taking them myself. The photos still shock me. From this side of the scars it’s easy to forget. Graham has just adapted to incorporate this new version of my body. He’s so grateful that I survived. He loves me.

My daughter returned from Europe and we have two precious weeks before she returns to university. I want to follow her around and embrace her randomly. I am so proud of her. She could have walked away from her studies without anyone criticising her because, after all, her mother had cancer. But she stuck it out. Her marks dropped but she still managed to pass two of the hardest subjects of her degree. Because the last eighteen months for me have been about surviving I haven’t been able to support her as I would like to have done. Now I can.

Her physical and emotional health have suffered. She’s working on being well. It’s been a shock to her to contemplate a world without me in it and it shows. I wonder if she’s realised that, like me, she is also temporary. Maybe that’s not a concept you need to come to terms with in your twenties although I know from the many young breast cancer survivors I have met that there are plenty who do. I pray for a cure. I pray for a future where she doesn’t have to fear my genetic inheritance.

My six month anniversary present was news from the Mayo clinic in the USA. They think they might have a vaccine that prevents the recurrence of triple negative breast cancer. I want to put fifteen exclamation marks on that. I still cry with joy when I watch this:

http://www.usatoday.com/story/news/nation/2015/02/03/mayo-clinic-triple-negative-breast-cancer-drug-trial/22785941/

It’s too soon to call this a cure. They’re just starting trials and the trials may yet prove that the treatment doesn’t work, but hope is like rain in the dessert when you’ve had cancer.

So, as always, here’s the photos. This is what my body looks like after six months of healing and taking very good care of myself.

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P1070194As you can see, the puckering to the left hand side is much better and I’m reasonably confident that this is going to keep improving. I’m seeing a massage therapist that specialises in oncology at least once a fortnight and sometimes more often than that. I highly recommend it. I’m also brushing my torso with my hands each night to help promote lymphatic drainage. The lymph system sits just under the skin so you really just pat yourself like you would a cat, with long strokes down the body. I can feel the lymph moving when I do this. It’s a mild tingling sensation. I’m hoping this helps me to avoid lymphedema, a common complication of cancer treatment.

The skin on the left hand side is also much better. This skin was damaged by radiation therapy and that’s why you can see such a marked difference between the two sides. You can also see the arc of a scar from my original breast conserving surgery above my mastectomy scar. I’ve been using macadamia or hemp oil, perfumed with essential oils, after my shower and that’s helped.

The question I get asked most often is “Will you be having reconstruction?”.  My answer is still “No”. I am very happy with my decision to do the best thing for my health and have the least amount of surgery possible. Even with all of the weight I’ve lost I still have a little bit of a belly. I’m very happy to have it sitting where it has always sat rather than having it surgically relocated to my chest, with all of the risks, pain and recovery time that would have involved. Just the thought of more than ten hours under anaesthetic was reason enough to avoid it but I’m also happy about not having any more scaring than was medically necessary.

Everyone makes their own decisions on reconstruction and, if you’ve decided to have it, then I sincerely hope you are as happy with your choice as I am with mine.

I’m still not inclined to wear ‘foobs’ (fake boobs). I don’t think there’s anything about my appearance that need ‘enhancing’. Of course, I’m also the kind of person whose happy with my prematurely grey hair, my glasses over contact lenses and my habit of saving makeup for very special occasions. There are some clothes that I know would look better with a bit of a mound. Perhaps, in time, I might have a look at something to go under evening wear but so far, so good.

Emotionally I’m feeling great. Thanks to Russ Harris and the ACT skills I’ve been practicing I now have an effective method for dealing with fear of recurrence. Losing 14 kilos since surgery (and only two of that was actually cut off me) has made me very happy but it’s really The Fast Diet that’s been a major contributor to my emotional well being. I am now in a healthy weight range because of a method that’s sustainable for the rest of my life. I can still enjoy great restaurants and the occasional take away without fear or guilt. The evidence on the benefits of this way of eating and the implications for those of us seeking to avoid cancer continue to mount. I am certain that I am doing the right thing for myself, my body and my family.

I know it’s still possible that the cancer could come back. Cancer is like that. But I don’t dwell on it. I enjoy my life. No, it’s more than that. I CHERISH my life, because I finally understand how precious it is.

Fear of Recurrence: Part 4 (Mindfulness)

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I sometimes wonder if the people that developed Acceptance Commitment Therapy (ACT) based their model on Buddhist or yogic philosophy. There’s some striking similarities. One of the most obvious is the use of mindfulness as a technique.

It seems that mindfulness, all on its own, is enjoying a popularity surge at the moment. It’s the subject of books, TED talks and articles. Most people are at least passingly familiar with the idea of being present, paying attention to what’s right in front of you, or around you, rather than the chatter that’s going on in your mind.

When you’re dealing with the fear of a serious illness returning, mindfulness brings you from your fears about the future all the way back to the present. It reconnects you with the activities you enjoy and the people that you care about. In the context of ACT, it helps you to turn your attention to your values, and to take action consistent with those values.

Russ Harris explains that when you’re dealing with a distressing event (or you’re upsetting yourself by imagining one) mindfulness is not a relaxation technique but a way to anchor yourself.

Here’s a simple mindfulness exercise. As you’re reading this, pay attention to the device that’s displaying it. Look at the different textures on the surfaces of that device. Are they reflective or dull? What colour? What brand? Are you holding the device in your hand and, if so, what does it feel like? Or if it’s on a surface in front of you, what is that surface. What is it made from? Now look around the device. What can you see? What can you hear? What can you smell?

If you’re similar to me then mindfulness exercises feel like moving out of your head and back into your body. I have a mild sense of waking up or reconnecting with my world. Please don’t misunderstand me. There’s nothing wrong with using imagination to create dreams, explore ideas, imagine possibilities. The aim is not to be mindful all of the time, but to spend more time being mindful.

One of the easiest ways to do this is to focus on your own breathing. Try this now and then use it the next time you start scaring yourself with thoughts of illness or death. Put one hand on your chest and the other on your belly. Take five gently breaths and focus on your exhale being longer than your inhale. (This also helps to prevent you hyperventilating. Suck in too much oxygen and you definitely will not feel calmer.) Breathe through your nose if you can. Notice how your breath feels cooler going in and warmer going out. Try to breathe all the way down to the hand on your belly. Notice the way your hands rise and fall with your breath. Hold yourself gently and kindly.

As you do this, remember that you’re not trying to get rid of your anxiety. You’re just trying to anchor yourself during a storm. Those difficult thoughts and feelings will keep trying to frighten you. Notice them. Thank your mind for trying to warn you and protect you. Recognise what a great story teller you are.

Now shift your focus to your five senses. What can you taste? Many people experience a metallic taste when they’re stressed. What can you hear? You might not be able to hear anything other than your own heart or breathing or you might be able to hear music, or birds, or traffic. Just notice it without judgement. What can you smell? What can you feel? It might be just the air on your skin or the places where your body comes into contact with your chair and your clothing or you might notice the air temperature or a breeze. Finally, what can you see? Look around you and notice the detail. Where are you?

I think that part of the reason yoga and meditation are so good for reducing anxiety is that they both incorporate mindfulness. It’s a powerful way to put ourselves back into the present moment. When applied to ACT, mindfulness also allows us to think about what it is that we really value, and what type of action would make our lives more meaningful. Nobody expects you to come up with strategic plans while you’re frantic about the future but mindfulness can give you, quite literally, the breathing space you need.

Once you’ve weathered the storm you can revisit your values and put together plans to achieve things that are consistent with them. You’ll probably keep having scary thoughts. Cancer is terrifying! But these techniques will help you to have a rewarding and meaningful life in spite of your fears.

I don’t plan on writing a post about how to make plans and carry them out. I think most people are now very familiar with the SMART model and ACT incorporates it as part of the ‘Commitment’ part of the acronym. Here’s a link to the Wikipedia entry if you’re not already using SMART or you can google ‘SMART planning model’ for more information:

http://en.wikipedia.org/wiki/SMART_criteria

There’s whole books written on this model and there’s no doubt that people using it are generally far more likely to achieve their goals than those that don’t but this is not universally true. Not everyone needs or wants a structured planning model and critics would argue that being too structured can blind you to the surprises and opportunities that life puts in front of us. I suppose the acid test is how effective you already are at setting and achieving goals. If you feel like you’re going around and around in circles then I’d recommend going through the SMART process, writing things down and then checking in regularly to measure your success. Like so much of life, the key is to actually DO rather than just understand.

Even if you think you’re pretty good at achieving your goals I’d encourage you to give the SMART model a try. You might find that it helps you to take effective action and to achieve more than you already do. I used to use SMART in a work setting and find that after years of use I now naturally slip into this framework when I want to achieve something. Revisiting it from the perspective of ACT has made me keen to try using it for something other than work. I’ve always been a lot more ‘free form’ in my personal life, perhaps because work was so structured.

This is the end of my four part series on dealing with fear of recurrence and I hope you’ve found it useful. ACT is a collection of interrelated tools that have been proven to be very effective in dealing with everything from PTSD to giving up addictions. For me, learning about this model and putting these methods into practice has resulted in a significant improvement in my life. I am calmer, happier and clearer about what I want my life to stand for. Even though ACT practitioners are very clear that the model is not designed to reduce or eliminate troubling thoughts, I have, like many people, noticed a reduction in them as a side benefit of practicing these techniques. I’ve also found that Russ’s book for couples ‘ACT with Love’, has strengthened my marriage and increased my considerable love and affection for my husband.

If you’ve read about ACT and thought it was too simple, or too difficult or just not you then I’d encourage you to at least try some of the techniques. It’s possible that you’re right. It’s also possible that you just might expand your skills and improve your life. Surely that’s worth a bit of your time.

Here once again is the link to Russ’s web site.

http://www.actmindfully.com.au

I would highly recommend his book ‘The Reality Gap’ to anyone facing a cancer diagnosis or dealing with significant anxiety about anything. Just remember that reading the book and expecting your life to change is like reading a cook book and expecting to eat. ACT only works if you do it. Yes, some of it will feel awkward and strange and even a bit stupid but that’s how you’re always going to feel any time you’re brave enough to try something new.

As I write all of this I’m thinking about 2015. It’s the first day of that year. I love the new year. For me it’s always a time of reflection and gratitude. It’s also when I decide on what I’m carrying forward and what I’m leaving behind. I spent this morning reducing my Facebook ‘friends’ list down to those people that I actually spend real time with and those that I would spend real time with if they lived closer. Gone are the friends of friends, the occasional acquaintances and the people I never really knew at all. ‘Unliked’ are all those pages that push stuff into my timeline and eat up the first couple of hours of my day. This is all part of a desire to spend less time online and more time leading my new, improved and very valued life.

Cancer has made one thing very clear. My time on earth is limited. The most important question I can ask myself is ‘How do you want to spend that time?’ For me, this year will involve more yoga, more painting, more cello, more gardening and, most importantly, more face to face time with the people that I love. I’ll be spending less time ‘liking’ or ‘commenting’ on the posts of people that probably wouldn’t invite me to a party if they threw one. Facebook is a wonderful tool for communicating with lots of people but it has become a time vampire. I suspect I may have become just a little bit addicted to it. Time to get back to life. Nothing takes you away from mindfulness as quickly as Facebook.

I wish I had never had cancer but I am very grateful for the person I’ve become because of it. Thank you to all of you that have shared the roller coaster with me. Thank you for your time, your comments, your kindness and your advice. My plan is to live until I’m 86 and to never ever have cancer ever ever ever again. Wish me luck.

 

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