Archives for category: Integrative Health

Today is Fathers’ Day. Giving my dad a gift is often tricky whether it is Fathers’ Day, his birthday, Christmas, Arbor Day, or Just Because I Love You Day. Unless I cook him dinner. That’s a gift he always loves as long as I don’t include mushrooms or zucchini or make anything too spicy.

But I can’t always cook for my dad for special occasions. Sometimes, I try to buy him something. When I was in college I used to describe my dad as “The man who has nothing and wants nothing.” It was an exaggeration and a joke to describe the difficulty of buying my dad anything! My brothers tell me about their gift giving challenges with Dad, as well. Sometimes we discuss our strategies for selecting a gift. I have settled on getting non-returnable items. This MOSTLY works.

You see my dad has a habit of refusing gifts because they are “too expensive”, “I only want a card”, and “I just want to spend time with my family.”  And he is being sincere that he would be happy with a card, a phone call, and/or spending time together.

However, there are gifts Dad will accept and he looks kind of happy to get them. So, gift-giving with my dad is a bit like playing a slot machine. Sometimes the payoff is big.

My dad gave a lot to us and that is one of the reasons we like to give him gifts. One of the gifts my dad gave to me was his love of taking photography. When I was a young girl, I remember that Dad decided that he needed a hobby. He chose photography. Dad purchased a good quality Nikon camera and built a darkroom in the house. I spent lots of time with him, at first watching him build counter tops and cabinets, and then later, I watched him develop film and make prints using his color enlarger. I remember how he worked to find the right balance of magenta, yellow, and cyan. I remember how used a piece of cardboard for dodging an area of an image to increase contrast.

Dad’s favorite subjects were nature. My parents love to be outdoors. My father has had many cameras and has been taking digital photographs for many years. I can’t imagine how many photos he has taken in the past 40 years, not to mention all of the old family photos he has copied and preserved.

I used to take a lot of photos. Some of them were good. Then I stopped. Then I started again with the camera on my smart phone. This gave me enough of a boost to buy a decent camera again, nothing too expensive, but a nice camera that takes nice photos.

I can never return to my dad what he gave to me in my life.

But I can give him the gift of my photography. And Dad, you can’t return this gift.

So there.

Happy Fathers’ Day. I love you, Dad.

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I had a weird dream last night. I went to a photography studio to get my picture taken. It was kind of a combination of high school senior photos and my wedding. Tom Colicchio a famous U.S. chef who can be seen on the show Top Chef was there. My former boss from the University of Washington was there. Once I got to the studio, I realized that I had left my shoes at home. I asked how much time there was left until it was my turn for Senior/wedding photos. I was told 30 minutes. I decided to go back home for the shoes. In an Elizabeth dream first, someone loaned me some sort of jet pack like device and I was able to fly all of the way home and most of the way back to the studio. (My daughter has lots of flying dreams. This was my first. I am growing as a person in my dreams.) Unfortunately, I ran out of fuel and had to run most of the way back. By the time I got to the studio, I realized that I’d again forgotten my shoes. I was also rather disheveled from running and had no make-up to freshen up. And for whatever reason, I was wearing a men’s sport coat over a white wedding dress. (Now that sounds more like a typical dream for me.) My old boss would be thrilled to hear that in my dream he helped me out by fixing my hair. The photographer was a sweet woman who let me borrow some shoes in my size as well as a tube of lipstick that she said was, “just my color.” Friends and strangers helped me out and put me back together again.

I think I am an imaginative person but I don’t fantasize a great deal. Well actually, I fantasize but my fantasies are usually pretty realistic. They are things that could really happen. I think this is one of the reasons I enjoy documentaries so much, especially those about every day people having meaningful experiences that are in the range of possibility for many. Last night, I saw the documentary, Walking the Camino: Six Ways to Santiago with my former Internet-only friend, Meredyth and her friend, Liz. We belong to a photography group on Facebook. The group includes a couple hundred people from all over the world. Meredyth and Liz live in nearby Vancouver, BC. They came down for the weekend and Meredyth invited me to the movie. We had the best time. There are a lot of lovely and interesting people in the world. Meredyth and Liz are both teachers and I can tell that they are very excellent teachers. It was nice to share our mutual love and commitment to children and their development. Liz, as it turns out, also belongs to the photo group but I have not seen her photos or interacted with her previously. Meredyth posted a photo to the group last night and awoke to a number of charming comments from group members about how happy they were that the three of us had met in “real” life. Most of the people in the group have never met one another in person. Meredyth and Liz were the first group members that I have encountered in the tangible world. I hope to meet more of my cyber friends in the future. It was a very special experience.

The documentary followed a group of people from all over the world, most of whom had never met previously. They were people who traveled to Spain to complete the Camino de Santiago, a long distance spiritual walk from one end of Spain to the other. Pilgrims have been making this walk for over 1000 years. The walk meant different things to each person followed for this documentary. Most of the pilgrims came alone. One set of pilgrims was a young mother, her brother, and her young son. They walked the entire trail, though the mountains, the plains, and the forests, pushing a stroller!

The pilgrims made new friends and were met with great kindness along the trail. People who fed them, housed them, and washed their feet. At one point, one of the pilgrims was so moved by the generosity of at stranger that she cried tears of joy and self-reflection. She was sure that she had never treated another person with the kindness that she had received. It was a beautiful moment because instead of beating herself up for not measuring up, she looked moved and inspired. The pilgrims also experienced ecstasy, times of great mindfulness of their surroundings, love, and lots and lots of struggle with their minds and the rest of their bodies.

A beauty of the film was that not only does the walk serve as a metaphor for life but the film also shows individuals having the day to day experience of transformation over the course of a month or so. I found myself thinking about how different pilgrims might integrate their transformation into the rest of their lives and for how long would they feel transformed and connected to something much larger than themselves or the small worries that consume us on a daily basis. I know that the answer to that question is different for every pilgrim and the answer changes over time.

I am still fighting the treadmill right now. I’m not going to lie to you. I am still feeling the sting of disappointment that my dream of taking my own pilgrimage to see all of my dear friends back East is just not going to happen any time soon due to responsibilities and financial realities. I also told my husband last night that it is unlikely that I will be able to contribute enough to our family income for us to save up for a big trip for our 25th wedding anniversary, which is in 13 months. I know this is a trip on which his heart was set. It was actually supposed to happen last summer so it’s already been postponed once.

Life is like walking the Camino, so is breast cancer. I have experienced both struggle and transformation. I have been the recipient of great kindness and generosity from both old and new loved ones in my life. These are the realities than inspire actual dreams of being unprepared for life and receiving help! (Although I believe I will be able to do my own hair and not need help from my former boss at U.W.)  I have learned the powerful and gentle gifts that come from walking outside. As one of the pilgrims in the film commented after having walked for hours through heavy rain (paraphrasing), “I saw the raindrops hanging from blades of grass. Painters paint this and I get to see it.”

I know why I like documentaries. I know why I steep myself in reality. I love life. Life is transformative, powerful, spiritual, inspiring, energizing, exhausting, loud, quiet, painful, scary, and at times very very boring. But life has everything.

Meredyth and me at the movies transforming cyber friendship to something more.

Meredyth and me at the movies transforming cyber friendship to something more.

John Gottmann, a psychologist at the University of Washington wrote a book called, “The Relationship Cure.” In it are strategies for strengthening marriages and other relationships. But Dr. Gottmann is a well known expert on marriage so that emphasis of the book is there. I have read a number of his books and know that one of the things he talks about quite frequently are perpetual problems. 69% of marital arguments are never resolved. And it’s not so much that happy couples need to resolve them as they need to cope with them together.

My maternal grandparents had a long marriage of 60 years. I wish I could say that it was a happy one but it was not. They had a number of perpetual conflicts but one I distinctly remember is the fight they had about a photo that my grandmother had taken with the Hawaiian entertainer, Don Ho. They took separate vacations by the time they were in their 60’s. My grandmother would frequently visit Hawaii to see their daughter, Judy and her family. My grandmother loved Don Ho’s shows. Apparently, he used to invite the grandmothers in the audience to take a photo with him. My grandmother, who was one of the most star struck people I’ve known, of course got the photo op. But she wouldn’t show the photo to my grandfather. I don’t know how many times I heard them yell at each other over some stupid photo. Like my grandmother would have an affair with Don Ho! But the argument was not about the photo. It was about some deeper issue that they were not able to manage. But because they were of a generation, a social class, and a religion that didn’t divorce, they stayed together for many unhappy years.

John and I have been together for nearly 27 years and we have our share of perpetual arguments. And conflict is part of any close relationship. It is to be expected and to be dealt with. But never in a million years would I expect to have a perpetual argument about a plant part, more specifically soursop leaves. Soursop is a fruting tree indigenous to Mexico, Central America, and the Caribbean. I first became aware of the soursop when I was visiting one of my best friends, Cheryl, for her mother’s funeral. Cheryl’s parents were both immigrants from Trinidad. Cheryl’s Uncle Norbert, a retired ichthyologist with more than a passing visual and vocal resemblance to Harry Belafonte, first told me about soursop ice cream. It is as I understand, an acquired taste.

Many years passed and I didn’t think again about soursop. Then I was diagnosed with cancer in late May of 2012. I had my first surgery scheduled for June 27th of the same year. One day, shortly after my diagnosis, John came home with a plastic bag of leaves. One of his co-workers had learned of my breast cancer and told John that tea made from soursop leaves would shrink my tumor. In fact, he thought it would help shrink my tumor even prior to surgery, which was scheduled for a couple of weeks later.

My husband is a software engineer for Disney Internet. The co-worker who gave him the leaves also had a high tech background. He was also rather eccentric, priding himself on storing his container of almond butter upside down so that the oil was easier to stir into it and it would remain creamier. I know this sounds snarky, because it is, but my mother taught me the same practical tip about peanut butter when I was a girl, with about 1/100th of the fanfare.

John brought home the leaves with instructions to make tea. I told him, “I’m not drinking that. Your co-worker is not a physician. He’s an engineer. And he’s weird.”

Okay, so that was not the best way to handle the situation but I was overwhelmed with information, trying to be the best patient that I could be, and the soursop leaf suggestion just seemed surreal to me. Go away, surreality. I need less of you. I am swimming in this cancer Hell hole as fast as I can. I don’t need any Salvador Dali in my life right now. My reality is spinning and melting enough as it is. Now, since it was so important to John I did a literature search on the use of soursop in cancer treatment. There was no evidence to support its use that I could find and some suggestion that it could be harmful. I considered his request considered, albeit in my own feisty way and ruled out for reasonable reasons.

As you might imagine, John was none too pleased with my response. He told me, “You only trust people with credentials.” Seriously? He said this as if it were a bad thing. Months later, he changed his criticism to, “You are so Western in your thinking.” I replied, “I believe that natural substances can be potentially very powerful for good or ill. I want to see an expert not just take advice from anyone. And by the way, you know I see a naturopathic oncologist and a practitioner of oriental medicine IN ADDITION to conventional oncologists, right?”

The argument comes back from time to time without resolution. I invited John to my last two psychologist visits as we work to transition from a crisis managing couple to a different sort of life together. The kind of  life that includes the possibility of cancer and has already included past cancer. We are still dealing with the aftermath.

The soursop leaf debacle was discussed during the last session we had together. John explained why it was so important to him. He said, “I wanted to cure Elizabeth’s cancer.” John clarified that he did not think that he was a physician or that he had more expertise than my physicians. But he, as my husband, wanted to “help” in a way that was “curing” my cancer. It was important that I understand this. I had no idea. It makes no logical sense to me. Why would John be expected to “cure” my cancer. There is no cure for breast cancer. And if there were, it would not only be known by John and another software engineer. In fact, it probably WOULDN’T be known by a couple of high tech guys.

But John is my husband who loves me dearly. I know that when he is scared, he is not always “reasonable”, in fact he can be downright romantic and sometimes nearly magical in his thinking when things gets really emotionally tough. And guess what? I am not the paragon of reason at all times. I get scared, feel out of control, and have my own little irrational dance that I do.

I don’t know what it is like to be a spouse of someone with cancer. I hope never to have this experience. But I know that it is important for me to try to understand my husband’s experience. This way we can cope with the conflict of the soursop leaves, which is really conflict about neither of us having control over the disease of cancer.

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As I mentioned earlier, I have been sleeping better since I semi-unplugged from Facebook. Now that I am not so frequently stimulating my brain, keeping it awake, I realize how tired I was. I’ve slept A LOT this week. I often feel kind of lazy when I sleep in and typically, my schedule does not allow for this option, anyway. Mid to late September are usually slow for child/adolescent psychology practices, though because families are focused on getting kids back to school and it’s too early in the year for teachers to refer most kids to me for evaluations. (Occasionally, there is a little kid who can’t keep from running around the classroom and into the halls, and all around the school. I hear from those families during the first week of preschool or kindergarten.) So I’ve been sleeping in. I don’t know if I’ll ever work off the 1+ year of accumulated sleep debt but I definitely feel less in the hole today.

Maybe I will actually be able to stay up past 9:00 pm tonight!

It’s all about attainable goals, people.

It is one of the blessings of old friends that you can afford to be stupid with them.
-Ralph Waldo Emerson

I had a very good friend, Mike, when I was high school. We did not go to the same school. We knew each other from summer music camp and we also played in a woodwind quintet together for a couple of years through a high school program at Cornish Institute for the Arts in Seattle. Mike played French horn. I played flute. In addition to being an amazing musician, Mike was smart, funny, and kind. His mother and grandmother had been interned as Japanese Americans during WWII. In high school, he was already involved in activism against racism. Mike and I graduated the same year, after which I stayed in Seattle to attend the University of Washington. He moved to Ohio and completed a bachelor’s in French horn at the Oberlin Conservatory. Mike visited me at college a couple of times when he was home for winter and summer break. I was thrilled that he would take time out to visit me, because he is such a great guy and all. Also, he told me that I should come to Oberlin because they needed good flutists. And also, because he missed me. (Swoon.) Oh wait, I forgot to mention something. I had a couple of big, multi-year crushes in my adolescence. Mike was one of them. And my crush on him was the only one that carried over from high school to college.

We wrote a few times and then we lost touch. After he graduated, he moved to New York and got a master’s degree in French horn from the Julliard School. Actually, if truth be told, I kept writing him and he either didn’t get the letters or stopped answering them. I was pretty steamed at him at one point but not because I still had a crush on him. I was dating John by then. It was because he had been a really good friend. And I HATE it when friends disappear.

In the years following high school, I came to suspect that Mike was gay. I worried that he’d cut off contact with me because he was afraid that I would disapprove. We were both raised in devout Catholic families. Our mothers had coincidentally both attended the same tiny all girls’, Immaculate Conception High School. We were both raised in pretty liberal households but Mike and I had never discussed our views on homosexuality. And times were a lot different 20+ years ago. I thought about writing him but that’s kind of an awkward letter to write. There’s no Hallmark card for, “I think you are gay and if you are that’s just fine with me and if you are not, that’s just fine with me, too. Have a great day!”

Once I learned how to Google, I periodically checked for Mike. He came up in searches frequently due to his activism (fairness for all despite race, sexuality, mental health status, or income) and also the 25 years he spent playing in the orchestra for Broadway shows in New York. But it wasn’t until five years ago that I actually found a way to contact him. Mike’s Facebook account came up on one of my searches. I didn’t belong to Facebook but I joined it in order to reconnect. And he didn’t remember me at first! And although as I suspected, Mike is gay, I don’t think our losing touch had anything to do with that. I think he just got swept away in his busy life.

I have seen Mike twice this year and although I have been so happy to see him more regularly, I have been very sad about the circumstances. His father died last spring. His mother died from ALS a number of years ago, not too long before I visited him in New York. Mike and his siblings all took turns taking care of their father, a month at a time. Mike now has a private acupuncture and herbal medicine practice in New York. He was leaving his business for a month at a time to care for his dad. Mike was also impacted by Hurricane Sandy during the same time period. He has had a really tough couple of years. And Mike is one of the most resilient people I know, which prompted me to write a post about him last March, when he visited me at the time of his father’s funeral, a couple of weeks after my TRAM surgery. (Mike has his own blog and wrote a beautiful post about his father life’s and transition to death. I highly encourage you to read it. You can find it here.)

Mike was in town again last week and I got to spend the afternoon with him on Friday. And although we had some deep conversation we also had fun. He looked less ashen than the last two times I’ve seen him. Mike’s spirit was lighter. We were silly. We were stupid with each other, like old friends are. I told him about the recording I made of my singing for my mom’s birthday. Mike told me that he didn’t remember the hymn by name. (I am suspicious about that.) He asked me to sing it. I sang most of the first verse and then he teasingly commanded, “now the chorus.” People, Mike is a professional musician who went to Oberlin and Julliard and he was sitting right across from me at a restaurant. I did not even have sheet music for that song, only the lyrics. I wasn’t even sure I sang the right notes at the right time or whether all of the measures I sang had the same number of beats in them! So I did what any three year-old would do and hid behind my napkin. Then we giggled like seven year-olds. We asked the waitress to take our photo. She took one photo and then asked us to be goofy. I have a really funny photo of Mike crossing one eye and keeping the other focused straight ahead. Knowing my Facebook posting habits, he immediately made me promise not to post it. (I looked cute in that photo. Sigh.)

Then we went to Lincoln Park, which is on the beach. While there, we fake fought about who the cute man who passed us was really smiling at. It was so fun to hear Mike joke again, just like when we were young. And since we are both in a lighter place in our lives than during our past visit, I told Mike the big piece of historical information I had been holding onto for the years since we reconnected. Now Mike knew that I had a crush on his for a few years. We have discussed that in the past. But what he didn’t remember was that when we were 16, he actually took me on a date! He did not remember but was so excited to hear about it and pumped me for the few details that I remembered. I remembered the super cool purple cotton jumpsuit that I wore. (Oh I loved that jumpsuit. Totally Sheena Easton! Or was it Olivia Newton John? I don’t know but it was totally 80’s!)  I told him that I think we went to a party hosted by one of the clarinet players from youth symphony. The only other thing I could remember was that she was blonde. I remembered that he showed me how to combine Jelly Belly’s into “recipes” (for example, pineapple + coconut + pina colada.)

“Mike, you were frustratingly gentlemanly. You didn’t even give me a hug good night!” He laughingly but sincerely empathized with my high school tendency to love the boys who I would later learn were gay. I know that a lot of it was that those boys seemed a lot safer than the straight boys. I think I would have had a crush on Mike, anyway. As I told him, “Okay, we were not compatible THAT way. But Mike, you had all of the other qualities. You were a wonderful boy and you are a wonderful man.”

It is wonderful indeed to have amazing friends. I am so glad to have Mike back in my life.

9/20/13, Photo by Michael Ishii, Seattle, WA

9/20/13, Photo taken with my camera by Michael Ishii because we disliked the waitress’ photos and he further disliked my photos. Artists…

My husband and I were walking the other day. He got hot and took off his shirt. John is a relatively fit man but like a lot of middle-aged men, he has a collection of adipose tissue (fat and other stuff) collected in the “beer belly zone”.

John’s father had his first heart attack in his late thirties and the one that he had at age 49 killed him. John is 48 years old and although he lives a very different lifestyle than did his father, I still worry. He has high cholesterol, which is controlled with a statin drug. But his trigylcerides are high again and his blood pressure, although still in the acceptable range, has been steadily climbing.

So the belly bothers me. It’s not as big as it was a year or two ago but it’s still there. Talking to a spouse about health concerns especially when it could also be interpreted as a criticism of physical attractiveness, is tricky. But it is really important that both John and I be as healthy as possible, especially now that we are painfully aware that physical health is not a guarantee.

I said, “John, I’m thinking that you need to do something about the fat you have around your mid-section.”

He said, nonplussed and gesturing like Vanna White over his physique, “My stomach? Look at me! I’m almost 50! I look damn good! But I am a man and we all think we look great.”

I don’t think all men think they look great. But John is one of the least physically self-conscious people that I know. He is perfectly comfortable with his body and honestly, he is quite a good looking man. And because he is not self-conscious, he won’t mind me saying that in college, he was perhaps one of the least stylish men I’d ever met. John wore incredibly thick glasses and the arms were attached with paperclips. He cut his own hair when I met him with kitchen shears, just enough to keep it out of his eyes. John’s shirts often had holes in them. But he was kind, funny, bright, studious, and comfortable in his own skin. These qualities were extremely attractive.

I admire John’s ease with himself. He is a 48 year-old man who has felt comfortable in his own skin for 48 years. I was 5 years-old when I first thought there was something wrong with my body. We were looking through recent vacation photos and there was one of me wearing a navy blue one piece bathing suit. At least two of my five brothers immediately started teasing me for being “fat”. I’ve been pretty open in my blog about my history of weight problems but I don’t think I was actually overweight until I was 12 or 13 years old, after which I lost over 20 pounds, grew, and maintained a healthy weight until I was 24 years old, at which time my up and down weight battle began. In any event, I wasn’t the slightest bit overweight as a 5 year-old!

I have struggled with body image for most of my life. And I’m not blaming my brothers but they were a layer in the onion of negative messages I received. There is a lot of pressure on girls to be unrealistically thin in our country. To be unhealthy is to be beautiful. I’ve always known this to be wrong. I was a reasonable and intelligent girl who grew up to be a reasonable and intelligent woman.

As I’ve written in the past, there was a tape that played in my head when I was overweight. As soon as I woke each morning, I felt the extra weight on my side and noticed how much closer the outline of my body was to the edge of the bed. I thought, “I’m fat.” Every morning of every day, on and off, for YEARS. And when I went out into a public place with crowds, I would compare myself to the people around me, “fatter than her”, “fatter than him”, etc. It was like a horrible, horrible tic. I knew how unhealthy it was. At times in my adult life when I’ve been at healthy weight, the tape has positive information but it is focused on weight and comparing myself to others. I knew that although a more comfortable state, it was still the trap of depending on my weight for a significant segment of my self-image. And I also knew that no matter whether I’ve been at healthy weight or not, I’ve avoided lots and lots and lots of opportunities to swim in my life because I felt uncomfortable wearing a swim suit. And people, I was an athletic girl. I even won the 8th grade award for physical education.

A few days after my breast cancer diagnosis, I gave myself a hard look. I had started back on Weight Watchers a few weeks earlier and people were asking why I would continue given that I had just learned that I had cancer. But I had already started to lose weight and from experience I know that there is a certain groove that is hard to find but once found, goals get achieved. I was pretty sure I was in that groove. Additionally, I thought it was a concrete thing I could do to improve my health at a time when I was feeling pretty out of control of my life. I decided to press on and wrote about this decision as well as my keen sense of embarrassment that a grown woman who was a generally happy person would have an evil tape playing in her head every day. I remember thinking for the first time that perhaps I needed to give myself a break for not being a perfectly self-accepting person and maybe the tape was something I just needed to accept about myself.

That bit of acknowledgement and acceptance was an important step in dealing with that negative tape. I focused on making good decisions in my cancer treatment and living a healthy lifestyle. I kept on Weight Watchers, I started mindfulness practice, and started exercising every day. I exercise by walking between 3 and 4 miles each day. I go out to walk with extremely few exceptions, every day, rain or shine. I walk in the winter when it’s dark (darn you, northern latitudes), cold, wet, and windy. I don’t really like to get cold or wet so I was kind of worried that I wouldn’t be able to keep up my walking during all seasons of the year.

I was able to keep it up and I discovered something about walking in the cold, the rain, and in the wind. I could do it and if I wore good gear, it could actually be relatively comfortable. It felt powerful to be vulnerable in the elements and to still have a good time. There’s ALWAYS some interesting life out there, the birds, the trees, the flowers. Bracing wind can bite but it can also be invigorating and as I’ve learned, it can also be the best medicine for an intense hot flash!

Admitting the existence of my negative body image tape was hard and embarrassing. But it was a confession that lifted something for me because it was no longer something that was too horrible to mention. Similarly, I admitted to a friend over a month ago that I was terrified of wearing a swim suit in public. It was a painful admission and I actually felt somewhat embarrassed and regretful afterwards about having made that disclosure. But I think just speaking it aloud wiggled something loose for me.

Meanwhile, the weather was getting hot and I didn’t want to bake on my walks. So I bought a jogging bra and shorts for my summer walking. I also thought it would be a good way to work on the body image project. Although I could deal with the shorts, having my midriff exposed was a little, EXPOSED. So I wore a t-shirt over it and got pretty hot on my walks. Then remember when I went hiking in the mountains? It was supposed to be cold that day so I was wearing a long-sleeved sports dress (there really are such things) over a sports bra and capri jogging tights. In the sun, high altitude, and my cancer-treatment induced prone to hotness, I soon got overheated. I debated for awhile but then thought, “Who would know me up here?” So the dress came off, my midriff was exposed, and guess what? Nobody died. Now I admit that it was a bit awkward given that everybody else appeared to have a normal thermostat and none of them looked over heated. In fact, some people were wearing stocking caps! So I was much more skimpily dressed than the rest of the people I encountered on the mountain trails. But again, NOBODY DIED, GAGGED, OR PASSED OUT.

Midriff in the mountains. Yes, my belly button is no longer round due to TRAM surgery. I kind of like the new shape.

Midriff in the mountains. Yes, my belly button is no longer round due to TRAM surgery. I kind of like the new shape.

Then it just got too hot on my daily walks and I found myself stripped down to a jogging bra and shorts about a third of the way through my neighborhood walks.  Just prior to my recent vacation, I realized that I was parading around the neighborhood in front of God and everybody, wearing something equivalent to one of the spicier Land’s End two piece swim suits for middle aged ladies. (And even the young girls frequently wear board shorts instead of bikini bottoms these days.) I realized that my problem was not with how much skin was covered. It was the negative associations I’d had with wearing a swimsuit or even the idea of wearing one, in the past. And by the way, in the course of my walks around my neighborhood, NOBODY DIED, GAGGED, OR PASSED OUT.

I decided that during my vacation, I would wear a swimsuit at least once. I wore a swimsuit twice with no adverse effects. In fact the 20-ish year old kid who rented me a kayak told me that I should jump off the bridge at the other side of the lake. Apparently, I was was looking confident enough in my attire to jump off of a bridge! Woo hoo! Spring break! Middle-aged lady gone wild wears swim suit while exhibiting good posture and providing no apologies. (I did actual consider the bridge jump briefly, remembered my fear of heights as well as my research training, and concluded that this would be manipulating too many anxiety variables at once.)

Last Sunday was another chance for me to work on this swim suit issue because we went to the water park with crowds of people. God was going to be there, too. But the roller coasters had turned out to be much easier than I expected, I was proud of myself, and pumped to expand the bubble of my comfort zone. I did it! I was in public, in a swim suit for hours. We actually bumped into one of John’s co-workers from Disney. Neither he nor anyone else at the park, DIED, GAGGED, OR PASSED OUT. It ended up being a lot easier than the Gordian knot I had envisioned in my head.

There were a lot of people at that park of various shapes and sizes not to mention taste level when it comes to swim attire. I found that the longer I was there, the less comparing I did. About midway through my time there, I looked around and the words that came to my mind in looking at the people around me were, “We are all God’s children.”

My life is really good right now. I am happier than I was before. I have a great deal of peace and joy in my life. And even with the waves of grief I have, there is calm and hope, too. The skin I’m in has a lot of scars, but they are fading.

I looked into the mirror this morning. The woman I saw looked healthy, happy, and like she had a few good stories to tell. Health is beautiful. Life is beautiful.

Yep it's me in an actual swim suit, not purchased from an antique store! And for extra credit, I'm wearing no make up and squinting into the sun!

Yep it’s me in an actual swim suit, not purchased from an antique store! And for extra credit, I’m wearing no make up and squinting into the sun!

After a couple of recent inquiries about my physical health, I realized that I have not provided an update for some time. So I will take out a bit of time from my concentration on my emotional and cognitive health (a post about my challenges with attention, organization, and memory is forthcoming) and focus on my medical status.

Medications

I started taking Lupron injections last summer. I now get one every three months and will continue to do so for a total of two years. Lupron “shut down” my ovaries by disrupting the signal between my pituitary gland and my ovaries. So my ovaries think my days of monthly cycles are over and done with. I am currently infertile and functionally in menopause. However, Lupron induced menopause is reversible. Once I stop taking Lupron, I may start my cycles again and go back to being peri-menopausal.

In October, I started taking tamoxifen, another hormone blocker. I will take that for a long time. At the time of my diagnosis, the usual treatment protocol was to take it for 5 years. Subsequent research suggests that 10 years might be better. I’m not going to worry about it because we’ll have more information by the time that decision needs to be made.

Other than those stupid hot flashes, occasional foot cramps, and having to work out harder to maintain a healthy weight, I have been very lucky and tolerated these medications very well. Knock on wood.

Scans

I have an annual diagnostic mammogram and an annual MRI, staggered by six months. I had a “clear” mammogram last January. I will have my next MRI in September, six months after my TRAM surgery. (Recent surgery makes it harder to read the images for MRI.) Both diagnostic mammography and MRI missed three of my four invasive tumors as well as a 6cm area of DCIS. A disadvantage of being “young” (under 50) in the breast cancer world is that our breast tissue tends to be denser because there is  higher water content. The water shows up as white on imaging as does cancer. So it’s hard to know. I have also read measurement research on the sensitivity and specificity of breast imaging techniques. Imaging should get considerably more sensitive as I age. However, the specificity of mammography in particular is not great. As you know, there is a high rate of false positives. But that was not my problem. My problem was of false negatives.

Surgeries and recuperation:

As many of you know, I had seven surgeries between 6/27/12 and 3/11/13. I know I mention this a lot. I also know that it is not a race as in she who gets the most surgeries wins! Let’s just say that one of the reasons I keep mentioning it is because I am still trying to believe it. And I kept my sanity that whole time. And I know that many of you out there have been through similar and even rougher treatment protocols. Let’s pause a second to reflect on our resilience. It’s really rather incredible.

Back to me, sorry, I told you that I was going to write a post about my ever-changing cognitive functioning. I had an appointment with Dr. Welk, my plastic surgeon last Friday. Even though I was feeling good and nothing appeared to be amiss with my healing, I was kind of nervous about the appointment as I had not seen him since April. I am happy to report that nothing appears to be amiss.

I am still slightly swollen from my TRAM surgery, which was 4 1/2 months ago. A significant portion of my sensation has returned to my abdominal area. There are no areas that are totally “dead” to heat, pressure, etc. I intermittently feel those little electrical shock sensations associated with nerve regeneration, especially right after my acupuncture appointments. And then after several hours of on and off shocks, I notice that I have more feeling. I just now read a plastic surgery abstract from a very small study of women post TRAM surgery. A good number of them had at least some sensation return. (Yes, it would be better to read the entire article but the journal was charging $30 for the privilege.) I had not expected any sensation to return and so had not mentioned this issue to Dr. Wang. I will talk to her about it next week when I see her. Perhaps there could be some welcome improvement in the “being able to feel stuff” department.

An unexpected positive is the fact that my abdominal strength is much better than I expected it to be. I had a pedicle TRAM procedure which means that one of my rectus abdominus muscles was sacrificed to create a blood source for the transplanted tissue. Microsurgical procedures can be used to prevent this but I was not enamored with the higher rate of complications and failed surgeries. There is a little bit of controversy regarding the pluses and minuses of these procedures but I am happy with the choice I made.

I am seeing Dr. Welk again in October after my follow-up MRI. I may have another set of plastic surgeries, which Dr. Welk said could be done in one office visit. (Dr. Welk’s time estimates are like dog years so this means two office visits.) The purpose of the procedures would be to improve symmetry between lefty and righty. But at this point, I don’t have to do a thing and Dr. Welk was very clear that this was a perfectly reasonable option. He provided a range of possibilities including doing breast enhancements on each side, which would involve getting a set of implants. For me, this is a big “no, thank you”. He was fine with that.

Healthcare visit schedule:

Currently, I see my breast surgeon every six months, my medical oncologist every three months, my naturopathic oncologist every 4 months, my Chinese medicine physician every two weeks for acupuncture, and my psychologist every two weeks. And I continue to get a full body massage every three weeks, something I have done for nearly 13 years now for stress and chronic pain management. (I had chronic neck pain for twelve years during my 20’s and early 30’s. It went away after two months of massage.) I typically have 1-3 healthcare visits a week, about half of which are across town or in another city. I am very lucky to have such wonderful care. The logistics, however, contribute to a frequently interrupted life and work flow especially on top of parenting duties.

So that’s the state of the union as of today. I will keep you posted and thanks to all for your continued support and concern.

As a child/adolescent psychologist, I work with a lot of moms. They often express feelings of guilt for their children’s challenges. I often respond by saying, “You have the rest of your life to feel guilty as a mother. Save some for later.”  This statement usually gets a laugh and often the guilt although not gone, is small enough for us to move forward in our conversation. It is often, however, not so easy. People get stuck. Even psychologically solid, reasonable parents can get stuck on guilt. Several years ago, I worked with a wonderful mom of a very young child who was showing signs of significant developmental challenges in multiple areas. She had professional experience working with children and was acutely aware that her son may have handicaps that would greatly change the future possibilities in his life.

Although there was no evidence that she had done anything to contribute to her son’s difficulties and further, it was yet unclear as to whether his difficulties would be short-lived or chronic, she felt guilty. She felt guilty and stuck. During one session I asked, “What do you think you are getting out of this guilt?” She looked at me understandably with a confused expression. I went on, “It may sound backward but sometimes people hang onto guilt because it gives them a sense of control in situations in which they feel totally out of control. We cannot have guilt without a sense of power, even if the power we feel is to harm.”

She was dubious but I had planted a seed. She came back a week or two later and basically told me that she had thought what I had said made no sense but upon careful reflection, it actually made sense. It was a turning point in her grief process.

Guilt is blame turned inward. It can also be turned outward. In Atom Egoyan’s 1997 film, The Sweet Hereafter, a town grieves for the loss of a busload of school children in an accident. Ian Holm plays an attorney who travels to the small town to file a class action law suit against the bus company. He has his own grief back story, which is his adult daughter’s drug addiction. Holm’s character tirelessly pursues blame. Someone must be responsible for the tragedy. That someone must pay. Things don’t just happen. They happen for a reason. He was going to find the reason at all costs. I won’t spoil the ending for you but let’s just say that letting go of blame and accepting the loss of control is a major theme of this film.

As for myself, I have had issues with letting go of anger. There is a release that comes with losing my temper and in the moment, it feels good. But because I am at heart a peacemaker and an empathetic person, I feel regret at having hurt other people, especially my husband. My anger is usually rooted in anxiety, anxiety that a problem can’t be controlled or solved. Anxiety that my house will never be an environment that I can control and make a sanctuary. Fears that my cancer will return. Fears for my family, especially my teenaged daughter. I have fears of not being a good enough psychologist when my patients are having particularly treatment-resistant struggles.

Most people would consider me to be a very disciplined person. One exception to this has been my life long struggle to eat healthfully and to exercise regularly. I love food. I am an excellent home cook and I love good restaurants. I love to eat a large amount of food. The act of eating is an amazing, highly enjoyable, sensory experience. It is also a wonderful social experience. And I know when I am overdoing it and often in my life, I just keep eating. And at these times, it seems too hard to put the time into preparing healthy meals. Quick and easy is convenient but not nutritious.  The rest of my health suffers and I just don’t feel as good during the non meal parts of the day. It also feels good sometimes, not to exercise. “Ah, I can just sit here and rest.” This is particularly true when I let my work and family life burden me. I work too many hours at work and at home, doing things and worrying about people. I am tired and I feel that I deserve to rest even though I know that I deserve the kind of treatment that promotes good health. But like many caretakers, I put my self-care low on the priority list even though I have counseled countless moms to avoid this. But putting my health at lower priority made my daily to-do list shorter. It made it seem like I was juggling fewer balls in the air. It was a false illusion.

In my 20’s, I gained and lost the same 20 pounds over and over. By my 30’s and 40’s, I have gained and lost the same 40 pounds twice. Right now, I have given up the convenience and the joy of eating to the point of indulgence for healthier foods. Yes, it is work to plan my meals, to make entrees ahead and freeze them in reasonably-sized portions. I take the time to make sure that I always have healthy vegetables on hand. I love vegetables and you know what, eating a large volume of vegetables is actually good for me. And I’ve gotten so that I look forward to my daily 3 mile walks. The key for me was realizing that I was self-employed and could therefore set my own hours! I am better at exercising in the morning and had been trying to add it to the end of long clinic days, which didn’t work at all. So, I just started seeing my first patients at 9:30 am instead of 8:30 am. What a rut I was in to not think of that solution years ago!

Letting go of these things has required patience, which does not come naturally. But I have grown and changed over the years. I have learned to manage my anxiety pretty well and with my mindfulness practice, I am learning to practice acceptance and further, that acceptance is not the same as doing nothing. It is not accepting that can spin me in circles, feeling like I am doing something but getting no where. Endless anxiety and anger can be a trap where you expend so much energy that it feels like you are doing something productive and your are not. And as a person who has been clinically depressed twice in my life, I can tell you that the helplessness and hopelessness of that passive state is one of the loneliest places in the world. I can’t tell you how thankful I am that I have not been near that place for over 10 years.

It can be hard to let go of anger, of grief, of impatience, or anxiety, of sadness, of guilt, at the point when I need to move on. Emotions are vital to our lives, even the “bad” ones. They motivate, protect, and educate us. But they do not always work in a healthy way with our thoughts and behaviors. I know that I will be working and reworking this balance for the rest of my life. I try not to think about how things “should” be in respect to things over which I have little control. I got breast cancer when other people with similar lifestyle and risk factors did not. I got it when people with more risk factors did not. Disease is part of the natural world and it doesn’t make sense to me to be mad at the universe. That just doesn’t work for me and the cost is too high.

We all have to make our own paths in life. In my life, I feel pretty unstuck right now but know that the cost of each day is a different set of gains and losses. Yes, I have lost the illusion of control but I have gained so much. I write this to reflect. I write this to remember the peace I have in my life at this moment.

I let go to gain freedom. I let go to go on.

Just like the Proclaimers, I have something to announce:

Today it is exactly 6 months since I started tracking the amount I walk each day. And today, I passed the 500 mile mark!

And a glorious walk, it was! Sunny with a pleasant wind full of beautiful plants, the sea, and friendly neighborhood dogs.

George Lakoff

George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. He is now Director of the Center for the Neural Mind & Society (cnms.berkeley.edu).

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