I woke up full of energy this morning, did some chores, and made breakfast for the family. I have managed so far to avoid violating my 24 hours virtually sugar free diet, required for the PEM scan tomorrow. The clinic calls it “sugar free” but I am allowed some veggies (green beans, cauliflower, asparagus, broccoli)  and I think there are sugars in all veggies. Let’s just call it a diet that is extremely low on the glycemic index. EXTREMELY LOW. I don’t think I’d make a good carnivore. I had two eggs with some cheese. (I would have thought that cheese would be on the verboten list since it is made from milk but have since read that lactose, the natural sugar in milk, is removed from the milk in the cheese making process.)

My energy soon went down the tubes after breakfast making and I took a nap. I’m still lounging under a blanket.

I got to get out in the yard and weed this morning. Yay! Here are some pictures of my Jungle of Delights!

Mindfulness is an ancient practice that has been adopted and adapted for use in psychological treatment, especially for self-regulation, in other words, not losing your shit. Two very famous people who are noted for their work in mindfulness are Jon Kabat-Zinn (up until 30 seconds ago I thought he was a psychologist and he actually has a Ph.D. in molecular biology; anyway, he is the writer of Full Catastrophe Living and other books) and Marsha Linehan of the University of Washington who developed Dialectical Behavior Therapy (DBT) originally for severely suicidal adults in the 80’s and over the years she has broadened her work to a wide variety of mental disorders and life circumstances that challenge emotion and behavioral regulation. (By the way, if you ever get a chance to hear Dr. Linehan speak in public, I highly recommend that you attend. I have heard her a number of times and she is amazingly brilliant and funny. You also may have seen the NY Times interview last year, when she disclosed her own history in early adulthood of suicidality, self-harm, and repeated psychiatric hospitalizations. She is quite a courageous person.)

I am on a mindfulness email list because I attended a FACES conference at U.W. a few months ago with my dear friend, Nancy Cohen. I received an announcement about the book, A Year of Living Mindfully: 52 Quotes and Weekly Mindfulness Practices. Each week begins with a quote selected by a mindfulness teacher, followed by a lesson, and a practice for the week. The book is divided into several themes. Being the Western-minded impatient cheater that I am, I skipped to Section VI, “Being in Difficult Life Situations: Stress & Suffering.” Here’s the quote (selected by Elisha Goldstein, Ph.D.) followed by the exercise. I invite you to join me this week if you feel so inclined:

Don’t turn away. Keep your gaze on the bandaged place. That’s were the light enters you.
-Rumi, 13th century poet/philosopher extraordinaire

Dr. Goldstein’s exercise (plagiarized directly from the book):

When you feel an uncomfortable feeling, try this experiment for a single minute:

“Breathing in, I feel this feeling; breathing out I let it be.”

You can shorten this to just saying “feel” on the in breath and “let be” on the out breath.

The instructions are simple, but the practice may not always be easy. Be kind and gentle to yourself through this process.

Okay kids, let’s be mindful. In the words of the Dalai Lama, “On your mark, get set, go! First person to the finish line wins!” (See, I already have the perfect mindfulness mindset.)

Okay, now for the second version of yesterday, the day we finally got the information from the pathology report. And I’m not complaining that people weren’t doing their job with the pathology report, they were trying to do an excellent job and to be careful. Slow and accurate beats fast and wrong any day. Even Aesop knew that. However, the process was fairly stressful. I had three appointments with three different physicians during the week. Each doctor was relying on the results of the pathology report to guide the appointment. The report was not available until the third appointment with the medical oncologist, Dr. Rinn. So John and I kept prepping ourselves for news, only to be told that no news or partial news were available. All of the physicians were very apologetic and did their best to get the information they needed before the appointments. I did know that Dr. Rinn had the report because her office called me in the morning to let me know that it had been received. As a healthcare provider, I know how hard scheduling can be. I know part of the rationale for chancing that the report would be available was to avoid having to reschedule me for weeks out. So to make a long story short, I don’t think my physicians have been careless with me but it was a very stressful process.

Now for the really stressful event. Yesterday, while waiting for my new patient visit with Dr. Rinn, I was approached by a nurse who is working with a research study. She asked to talk to me about participating in the study, which compares a number of different chemotherapy regimens to one another. This was very upsetting to me because I had not yet met with Dr. Rinn about my treatment plan and up to this point, I have been told that my chances of needing chemotherapy are low. As someone who used to work at Harborview on a medical research project, I also knew that this woman probably had access to information from my medical record, possibly even the long awaited pathology report. She also told me that she was talking to me because Dr. Rinn thought it was a good idea! So, we were sitting in the waiting room, confused, thinking that someone’s hand had been tipped and we did not have an opportunity to ask questions or anything. Finally, I told the nurse, who I think is likely a very nice person who is just trying to help people, that I had not yet met with Dr. Rinn, seen my pathology report, and didn’t even know if I was a candidate for chemotherapy. I also told her that I had been a researcher for 10 years, was a psychologist, and that it was very upsetting to be approached prior to my even being able to meet with my doctor. She was extremely apologetic, explained that she didn’t even know if I was eligible for the study, and then walked away. I saw her in the hallway of the clinic with her head hanging low and I felt sympathy for her. I know she didn’t mean it and I could tell she felt really badly for having upset me. I did, however, feel strongly that my feedback was appropriate. Little changes in research protocol can make a big difference and this is one of those times.

Miraculously, my dear friend Nancy called at just this time to ask me how I was doing. I told her, “Your timing is perfect because I’m really upset.” I explained the situation to her and she agreed that it was possible that I am a candidate for chemotherapy, but more likely, that this was some misstep on the part of the research study recruiter. Couching her comments with “Well, I’m not an oncologist, at least the last time I checked”, Nancy explained that women in my situation usually need oncotype testing to determine whether chemotherapy is necessary and that results of that testing take weeks after surgery so it would be unlikely that the testing had been done considering that I only had surgery last week. Then she kindly said, “You want to just keep talking about stuff until it’s time for your appointment?” So we chatted for awhile and then it was time for the appointment.

Dr. Rinn brought up the incident herself saying that the nurse had called her and left a voicemail. She was very apologetic, explaining that I should have never been approached prior to my consultation with her and further, that I do not even qualify for the study. Dr. Rinn also said that the research study nurse is a very nice person but was glad that I had told her that I was upset and suggested that they make sure they approach patients after they have a treatment plan with their physician, not before. She also reassured me that I still have a low chance of needing chemotherapy and with my permission, ordered oncotype testing, just as Nancy had predicted.

Phew!