Making time

May 15, 2014 //

As I mentioned in The Hours, taking care of myself as a breast cancer patient is time consuming. For example, I still need 10-12 hours of sleep per night. I walk an hour to an hour and a half nearly every day. My wheat allergy coupled with the diet I eat to help maintain good health means that I eat very little prepared or processed food. Cooking from scratch takes time. I still find myself in health providers offices 2-3 times per week. And I work for a living. Right now, I bill about 18 hours per week. Twenty hours per week is considered full-time for a private practice psychologist. I used to bill nearly twice that much but admittedly, that was pretty unhealthy. The way I explained it to my husband was, “Imagine that you lost four hours of every work day and had 2-3 doctors’ appointments every week.”

And it’s not just trying to find time for work. It’s trying to find time for a social life, to spend time with my husband, and to spend time with my daughter. I have been looking at what I can give up to free up my time. There are some things like blogging and walking that take time but I will not give them up. My blog writing ebbs and flows in frequency. When I have a lot of ideas, it is because I have a lot on my mind to process and it is helpful to write about it.

I stopped seeing my naturopathic oncologist several months ago. I follow continue to follow her recommendations. We had transitioned to a maintenance schedule, anyway. I was also on a maintenance schedule with my acupuncture appointments. I was getting them every three weeks, traveling to a different city to get them. I told her I wanted to see if things continue to go well and check back with her as needed. I have decided that I am done with reconstruction and have no scheduled appointments with my surgeon. This means that I have scaled back to medical oncology appointments every three months, onco-surgery follow-ups every six months, massage every three weeks (I have been doing that for 13 years to manage chronic pain and stress issues), an annual mammogram, an annual MRI, a yearly physical with my internist (I am now one month overdue), psychologist visits every 2-4 weeks, and a trip to the dentist twice per year. I am still figuring out how to work in a dermatology visit as well as a trip to the eye doctor.

I have also opened up more work time by working on the weekends. I don’t work more than an hour or two each day but I don’t really like to do that. Due to logistics, cutting back a little on my practice means cutting back too much, due to the number of hours each of my testing patients requires. So I’m stuck between working a little less than I want to, which is boring and strapping us for cash or to work a little more than I’d like to. I talked to my husband earlier in the week and told him that I wanted to try to build a week off into my schedule every quarter. Because he is awesome, he quickly told me that he thought it was a wonderful idea. So, I’ve already taken off a week for New Orleans and have a vacation coming up in the summer.

I am so grateful to have flexibility in working all of this out and I will keep working on it since my energy level and responsibilities are still somewhat of a moving target.

Tags Breast Cancer, family work balance, self care, time management

Categories Breast cancer, Family, Parenting

Mental Health Blog Day #mhblogday: I can deal

May 14, 2014 //

Today is the American Psychological Association’s Mental Health Blog Day. Since I am a clinical psychologist, not to mention a member of APA, I am republishing a post I wrote last fall, “I can deal. As I’ve disclosed in the past, I have a history of major depression. I have not had a depressive episode in over ten years. I attribute my years of good health even with enormous life stress to a combination of treatment (ongoing medication and psychotherapy, as needed), exercise, mindfulness meditation, good coping skills, and wonderful friends and family. One of the reasons I write about my own history of mental illness is that so many people fear it so much that they avoid getting support or even admitting that they have challenges. As a mental healthcare provider, I also know that people in my own field tend to either embrace the support that our field offers or to avoid using services or even the support of friends. If you are suffering from mental illness or even just unhappiness, what’s the worst thing that could happen if you sought out support? And what’s the best thing that could happen? You could get a lot better or at the very least, you would no longer have to suffer alone.

Today, my brain feels pretty functional and I feel calm despite the fact that I still have a number of unknowns in my life including the results of my MRI from last Friday. I spent a good 2-3 weeks up until last Friday on a roller coaster of anxiety. I can’t remember if it was Wednesday or Thursday of last week but on one of those days I was a mess for a few hours. I was so worried about my MRI and the prospect of going through cancer treatment all over again. I have had plenty of sadness and fear. This was different than in times past. As I have written, I have felt storms of emotion at different times during the past 1 1/2 years. But at my core there was a sense of peace and calm.

How was my core different this time? In addition to the stress around the MRI being scheduled, then cancelled, then rescheduled (I hate that kind of stuff), about a week or two into that whole mess, my energy dipped precipitously. I was really really fatigued. Like everyone else, I have a low energy day every once in awhile. But I had several in a row. And the fatigue felt different to me, it was the kind that can pull me down into very sad places. This scared me. Anxiety followed by prolonged fatigue is how my depression has started in the past. And I have had periods of time, especially in the winter when I experience this fatigue and although I can never be certain, it feels like the start of a depressive episode that never happens because I am able to fight it off with my medication and cognitive therapy techniques.

I have not had clinical depression in over 10 years but it has been a strong concern of mine that I would have a recurrence due to the stress of being a cancer patient. So I was really scared last week and although I talked to a few people about the fears I had about cancer recurrence, I told no one, not even my husband, about my fear of being depressed again. I felt isolated, lonely and guilty about being a very needy person. I was still able to work and behave with a semblance of normalcy when it was very important that I did so.

By Thursday night, I started feeling significantly less stressed. I had gotten the core of peace and serenity back even though I was still distressed. But I wasn’t entirely back to whatever “normal” is these days. My emotional states change so much more frequently and intensely than they used to and I understand why they do. I can live with the “normal crazy” of cancer treatment. I am still myself but in technicolor. When I am depressed I am not myself. There are some people who have persistent depression, which tends to be a steady, low level misery.

In contrast, when I’ve gotten depressed, it has been acute and more severe. I fell into a very scary, powerless, and hopeless chasm, into a world where I could act like myself for some periods of time but it was acting. And I didn’t feel like myself at all. The first time it happened, I kept thinking that if I just kept problem solving, it would go away. So I let my untreated depression go on for some time. The second time it happened, I recognized it within a week or two and thought, “Oh no, we’re not doing this again” and got myself back to see a psychologist and my internist within a week and my symptoms started subsiding very quickly, within a couple of weeks.

Now that I’m writing this, I am realizing that I handled that last episode pretty well. And I am also still seeing a psychologist every month, not to mention all of the healthy things I do that are good for both physical and mental health. Depression, you are not welcome, but if you come anyway, I can deal with you, too.

(Update: The results of the MRI showed “no evidence of disease” and that is my current breast cancer health status.)

Tags Breast Cancer, coping with breast cancer, depression, fear of recurrence

Categories Feelings, Mindfulness

Coasting

May 13, 2014 //

When I was a girl, my younger brother, Jim frequently rode our bikes. I remember the pumping my legs furiously so that I could coast along for awhile without having to do anything to propel myself. It was exhilarating going down hills and on the flat, it created joyful stretches of ease, moments of effortlessness.

Being a healthy person, having a healthy marriage, and being a good parent are all “works in progress”. When John and I saw a psychologist for marital therapy years ago prompted by family planning issues, I asked her sincerely, “When is the time when we get to coast in marriage?” She promptly responded, “Never.” I remember my shock at her response at the time. It’s kind of funny looking back at my thoughts at that time. I do know that I was quite overwhelmed by my life and about to enter my second episode of major depression. It was a fantasy I had that after all of the hard work I had done in my life, that I would be able to coast. I would have an easy time as a wife, parenting would get easy.

I was reminded of my wish to coast recently when I realized that after all of my hard work, I had strayed off of Weightwatchers and begun to gain weight. I didn’t gain a lot of weight and I’ve started losing again. It may not seem to be a big deal to you but I have gained and lost weight many times since I was 14 years old. And as I have mentioned, the last two periods of weight gain had put me into the clinically obese range. My breast cancer was highly responsive to estrogen and progesterone. Our adipose tissue (fat and other stuff) has glandular function and increases female hormone production. I know it is important for me to exercise and eat right. I am very lucky to not have physical issues that would interfere with my ability to exercise and to have a life situation that makes it possible for me to work part time. But even knowing these things, my weight has crept up in the past when I stopped paying attention to my habits, when I tried to coast in my life.

I have lived a good bit of my life working at capacity and feeling fairly stressed out. At these times, I have thoughts like, “It will be SO much easier, when ____________” This blank has been completed in many different ways over the years, “when I finish school”, “after the baby starts sleeping through the night”, “after my career is established”, “after my daughter is grown”, “when my husband’s job situation improves”, “after my cancer treatment is done”, “after my energy returns”, “after I start working full time again.”

But the truth of the matter is that although stress ebbs and flows throughout out lives, we are never done with it. And there are always unknowns and unexpected challenges that loom on the horizon.

In my work, I specialize in what for most children are chronic difficulties. And although many of them have loving and very skilled parents, even the most loving and skilled of the parents gets exhausted with the extra work their child or children require. There is also a period of adjustment after diagnosis that can take anywhere from weeks to more regularly, years, and sometimes, never. It is the adjustment to the idea that there will be no coasting as a parent and that one’s children will likely need more support and over a longer number of years, than other children.

I sometimes use an analogy with parents. I tell them, “Raising a child with these challenges is like running a marathon of unknown length and unpredictable terrain, with uphill, downhill, and stretches of flat. It is important to take the cups of water whenever you can.”

If I really think about it, coasting on a bike only lasted so long before I either had to brake because I was going too fast or start pumping my legs again so I could keep going. I have been working hard to take care of myself but also to nurture my relationships and carry out my responsibilities. I will keep working on the rhythm of knowing when to pump and when I can coast so I can keep moving forward and maintain my balance. And if if that little cup of water looks too small to last a lifetime, I will take them when they are offered.

Tags Breast Cancer, mindfulness, Parenting, parenting children with special needs, self care, stress, work/life balance

Categories Breast cancer, Family, Mindfulness, Parenting

The bandaged place

May 11, 2014 //

My daughter saw it for the first time. She saw my TRAM scar. She had been very careful to avoid seeing any of my surgery scars especially a year ago, after she saw my very small and tidy scar that runs the circumference of my belly button that was a result of TRAM reconstruction. Seeing that little nothing of a scar was upsetting to her. She is not squeamish. It upset her because as she explained at the time, “They did it to MY mom.”

I was trying on blouses. I had to wear one in the charity fashion show with jeans. My daughter also happened to be trying on clothes and since I have a full length mirror, she was coming in and out of my room.

She happened to walk in when my TRAM scar, which sits about 3 inches below my waist, was exposed. She said, “Mom, your scar! That must hurt!”

The scar is wide; it arcs from one hip to another. I have been told by physicians that it is an incredibly neat scar for a TRAM; my surgeon is extremely skilled. It has faded over a year’s time. But it is still red and the vertical suture marks are quite visible.

I explained, “It doesn’t hurt any more. But yes, it was a big surgery and it hurt a lot at the time. That’s why it was hard to get around and why was home for seven weeks.”

She listened relatively attentively and then went on with what she was doing. This was the longest conversation we have ever had about one of my surgeries. She didn’t run from the room. She didn’t say, “Mom! I don’t want to talk about it!”

When I first had my TRAM surgery, I could not stand upright and I was instructed not to do so for some time to avoid damaging any of the internal or external stitches. I couldn’t laugh for awhile. I could feel my strain of my tissue against the edges of my sutures, which were basically holding me together. It burned like Hell. The same thing happened if I sneezed or coughed.

Currently, I have no evidence of disease. The searing and burning fear of cancer have faded for now along with the physical discomforts and pain. There were times, early on, when my daughter was so anxious about my cancer that she paced like a caged animal.

My daughter is a teen and her life is complicated. Most teens have a lot of emotional tumult in their lives. It is the norm and it is part of the re-organization that takes place that allows them to grow and become independent. I know my daughter’s emotional plate is full without having to worry about her mother. And I hate that. I hate that she has to deal with her mother having had a life threatening illness and that she has to deal with the possibility of recurrence. It’s a loss of innocence; I don’t know if she really appreciates that.

I’ve never been an emotionally perfect mother. I work to be as healthy as I can be. And I can’t expect myself to be a physically perfect mom, either.

The love I have for her, though not perfect, is infinite. I am so happy to be a mother and I am beyond blessed to be the mother of my remarkable girl.

Tags Breast Cancer, healing, Mothers' Day, scars, TRAM surgery

Categories Breast cancer, Parenting

Empty

May 10, 2014 //

I was walking through the woods and I noticed her out of the corner of my eye. I snapped some photos using my phone and I memorized her location.

A humming bird sitting on her nest! I was thrilled! I ordered a real camera to take better nature photos. And the next day, I found this.

An egg! The tiniest egg you could ever imagine. A tiny little package of life.

This was the only view I got of the egg. Here’s a little video of the time she was kind of peeved with me for getting too close to her.

After a couple of days she seemed to get used to me. And she sat on that little egg, day after day. I was thrilled to have a chance to see the miracle of life in the nearby woods. Hummingbirds are small and feisty. And this mama, despite the fact that she has the brain the size of a pea, had the instinct to protect her baby. She knew how to fly around to make herself look larger and to make lots of noise. And she also knew when it was time to quell her own instinct to flee and to stay sitting on that egg.

This is a photo I took on a very rainy day. She sat there with the rain dripping on her head from the little twig above her. I thought it was a good metaphor for a mama’s love.

Every day or two, I visited the nest. I had done a little research on hummingbirds and learned that the gestation time would be 16-18 days for the egg to hatch. So, not knowing how recently she had laid her egg when I first found her, I expected to see a chick within a couple of weeks. I kept visiting and started feeling a little impatient because day after day, there was no chick.

Then I went to New Orleans for a few days. John and I walked back into the woods the day after our return.

Still no sign of the chick! It is possible that there was a chick under mama but it had been far longer than 16-18 days! Rip off! Where’s my miracle? Isn’t this a zoo?

Then it happened! A chick, a chick, a chick!!!!!!

I visited the chick a couple of times. I was planning to keep taking photos of the chick’s growth, the increase in feathers, and how little bird get loud and demanding as they await food from mamas who are scurrying around to get food for a baby who grows to her size.

Today, John and I set out for the woods. It was a breathtakingly beautiful Seattle spring day.

Nothing. Empty. That chick was still small and homely two days ago. Sometimes nests are empty because a chick has gotten strong and fledged. But other times, they are eaten by a predator or fall from the nest. This chick, whom I’d affectionately called my “grand baby” and who my Facebook friends had fussed over, is dead.

I had been saving my photos for a post on this blog. This is not the post I had in mind. But life is still a miracle and this Mama did her best, as we all do with our children to help them be strong enough to leave us.

Mothers’ Day is typically a very happy day for me. I have a close relationship with my mother, who is a healthy woman. I have a wonderful daughter. But I know that it is a day of loss for many. For those of you who have lost your mothers, who have lost your children, or who wished for children who were never to be, Mothers’ Day has a much different meaning. And then there are those of us who are mothers who understand that we can’t take our own health for granted. We pray that we will be there for our children as long as we can, especially while they are still chicks in the nest.

Life is full of mixed feelings. I hope that at least one of the feelings you experience tomorrow is serenity. If you are a mom who has lost a child, I know you worked to love and protect your children. If you are a daughter who has lost a mother, I know you brought moments of great joy into your mother’s life just by being her child. If you wanted children but it was not meant to be, think of all of the children to whom you have mattered by being a nurturing presence.

Tags loss, Mothers' Day, Nature, Parenting, rufous hummingbird

Categories Family, Flora and Fauna, Mindfulness, Parenting

Artsy, colorful, and a little dirty

May 7, 2014 //

Yes, I know I’m posting a lot recently. And I’m still not caught up with my posts for New Orleans!

As you know, I would like my house to be much cleaner and better organized. I have been focusing on the fact that I live with very messy people. Although this is true, I also realize that I am railing against the consequences of my reduced stamina and the fact that I have to sleep a lot. I just don’t have the number of work hours available in a day that I used to have. So, I’ve been doing less cleaning and organizing myself. And my husband has had to pick up a great deal of the parenting load.

Today, I had a thought. “My house is artsy, colorful, and a little dirty.”

For some reason, that does not sound so bad. The “little dirty” is perhaps a minimization but I could argue that it’s only “a little dirty” because outside of my daughter’s room, a snow shovel is not a required cleaning tool.

An “artsy, colorful, and a little bit dirty” house actually sounds like fun. A good house for a get together where you don’t have to remember to raise your pinky when you sip your tea.

I am going to try out this little re-frame and see how it goes.

Categories Breast cancer, Family

Protected: This is a test

May 7, 2014 //

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Categories Uncategorized

How long have you been cured?

May 7, 2014 //

“How long have you been cured?”

Her question caught me by surprise. We were riding on a school bus from a beauty salon to the venue for the breast cancer charity event in which we were both modeling. I knew that she was diagnosed less than a year ago. She was self-employed and had benefitted from the charity first hand.

I answered, ‘I was diagnosed almost two years ago.’

I could have corrected her but I didn’t. She had also invited everyone to a potluck at her house. I could tell that she was having a powerful experience of belonging, being surrounded by 29 other women who had been diagnosed with breast cancer as recently as 9 months ago and as long as 19 years ago. I could also see the fear in her eyes, that she had transitioned from the shock and adrenaline rush of the active treatment stage to “Now what?” I figured that I needed to respect her grief process and trust that she would progress in her understanding of her disease.

Her question reminded me of past experiences. I grew up in a politically and socially liberal Roman Catholic church. We didn’t talk about Hell or who was going there. We didn’t talk about “being saved”.

So the first time I was asked, “How long have you been saved?” I was similarly taken by surprise. It just wasn’t the way I was used to thinking about myself because my religious upbringing was different.

I talked to one of my colleagues and friends about this a few years ago. He is a thoughtful man, raised Lutheran who is now a practicing Unitarian. He was shocked that I had been raised without the reassurance of going to Heaven. He’d found this belief quite comforting while growing up.

Being cured and being saved are absolute positives. They can mark an end of struggle and an end to gray.

I don’t wish to disparage anyone’s beliefs as long as they don’t hurt others. My personal belief is that God is beyond my complete understanding but that I experience God is in the love people show each other, how we take care of our world, and the beauty of nature.

I don’t know if I am cured. I don’t know if I am saved.

I know that I am here.

Tags ambiguity, Breast Cancer, mindfulness, religion, spirituality

Categories Breast cancer, Mindfulness, Religion

Look me in the eye

May 6, 2014 //

I sometimes work with parents who reluctant to give their children any kind of correction or to communicate to their children they they have any kind of imperfection. Then there are other parents who criticize their children harshly. And still other parents vacillate between those two extremes.

Sometimes I tell parents that it is important not to be so reluctant to discuss their children’s less than perfect qualities. I explain, “You don’t want to give the unintended message that your child’s challenges are too horrible to speak of.”

The other unintended message is that perfection is attainable and expected. My massage therapist expresses the belief that everyone is perfect. I know what she means but to me, it seems like a cheat. If I were to think about myself that way, it would seem like a way to avoid looking at myself fully, a way to avoid acknowledging and examining the parts of myself that underscore my membership in humanity.

I know that I write about painful topics with a good deal of candor. And I also know that I expose my faults. Sometimes I think people worry that I am too self-critical. I find that for myself, if I avoid thinking about my faults, I give myself the message that they are too bad to be observed or examined. This kind of thinking can provide a foundation for very difficult feeling states like shame and humiliation as well as the very damaging thoughts and beliefs that accompany them. I believe it can also lead to living a fragmented or compartmentalized life, the kind of life that makes it hard to see oneself as an integrated whole. To me, it is important that the way I live my life makes sense. I can’t do it unless my imperfect pieces fit together in some kind of reasonable way.

In my life, I have felt guilt, shame, great anxiety, and humiliation. It is difficult, but I try to see myself for all of who I am, the good, the bad, and the in between. In writing about myself for the past two years, I have discovered something. I have discovered more freedom from my own harsh judgment. When I confront both my positive and negative qualities, I feel better able to decide how I want to live my life and to make changes, if needed. By describing and admitting my shortcomings, I find it easy to accept myself and further to grow as a person. In turn, I find it easier to accept others.

I have yet to find anything about myself that was too horrible. I am still working on it, but almost always, I can look myself in the eye.

Tags mindfulness, self-acceptance, self-awareness

Categories Mindfulness

Put a cork in it

May 5, 2014 //

As I mentioned last week, I am dealing with anger. I am pretty sure that it is about my stupid cancer. Getting sick for my New Orleans trip was really disappointing. I had seen it as an opportunity for a romantic “second honeymoon”. Adding to the frustration, the trip almost didn’t happen and was also quite expensive.

We still had fun but I’ve got to tell you, sitting on the plane on the way over was pretty uncomfortable. I was coughing a lot, I mean A LOT. I believe that I was the least popular person on the flight. The man sitting next to me had his body turned as far away from me as he could. A kind woman behind me handed me a cough drop. I already had one in my mouth not to mention the fact that I was fully loaded up with cough and cold medicine. And then I started having abdominal muscle spasms, which made me cough even more. That was a new one for me. I wonder if it has something to do with the abdominal muscle that was re-purposed for my TRAM reconstruction. I think that by the end of the flight, the man next to me was wishing that he’d sat next to a screaming toddler instead of next to me while I spewed my plague all over the coach section of the plane.

We arrived to New Orleans at about 3pm on Saturday. I took a short walk to the French Quarter with John. We walked down Bourbon Street until I finally said, “Yuck, I’ve gotten enough of an anthropological experience.”We walked over one block and had a delightful change of scenery to art galleries and such instead of Hustler clubs with horrible names like, “Barely Legal” with young and not so young scantily clad women standing in the doorways.

Sunday was our only full day without any band performances to attend. In the morning, I felt like I’d been run over so after John brought me some breakfast, I went back to sleep and didn’t get up until 4pm. I know I felt a lot better, showered, and got dressed for dinner. I have no recollection of where we went or what we ate though I know we walked there from the hotel, at my insistence and John’s objection. (I was still going to get in my 3 miles of walking in each day.)

On Monday, we went to a band performance, which went well. Then we took the street car to the Garden District to soak up the ambiance and to tour one of the cemeteries. We did a lot of walking that day. There were definitely some positives but I must admit that I was in a foul mood and complained a lot. Then John complained about my complaining and I said lamely, “But I’m sick! On our vacation. Waaaaaaaaaah!” (Okay, I didn’t really say, “waaaaaaaah!”) His suggestion was, “So you’re sick. Can’t you just make the best of it?” “But I am!!!!!!! I am out of bed!!!!! Also, your wife is sick and cranky. YOU make the best of that.”

So at this point of reading this post, you may feel sorry for my husband. And if you do not, you probably should because although I snapped out of my disappointed child routine for the couple of days following, once we’d gotten to the day after the fashion show, I was exhausted and mad again.

I was annoyed about every little thing. I have not been in a nasty mood like this in quite some time. And I don’t remember the last time it lasted an extended period of time like this. And John got the brunt of my perpetual dissatisfaction. I actually felt a lot better after I wrote my post complaining about how John often doesn’t answer me when I talk to him. Writing has a way of doing that for me. But by last night I was exhausted and fuming again. “Why is this house such a mess? Why do I have to live like this? This isn’t the way I want to live!”

Truth be told, although my husband is not the best at housework, he is a really hard worker. He is really bogged down with work and helping our daughter keep on top of her schoolwork. She missed nearly an entire week of school for that band trip and she takes a very difficult schedule. John spent many hours with her over the weekend sorting through what she missed, what she has to turn in, and what assignments needed to be done over the weekend. She is not easy to help, either, and is prone to getting frustrated and losing her reasoning skills. “What do you mean I have to answer in paragraphs? What does that mean? This is so stupid!”

He was so patient with her all weekend and here she and I were providing grumpiness in stereo. By the end of the night, I was feeling pretty remorseful. Today, my first thought was, “Put a cork in it, Elizabeth.” I know that my anger is very understandable and that I need to process it. Managing anger is tricky, though. There are ways of dealing with it that make it worse, for example, constantly complaining to one’s husband.

Maybe writing this post will help. Maybe I need to keep reminding myself that my anger, just like sadness and fear, do not last forever.

Even though all feelings are right. Anger FEELS wrong and I find myself looking ways in which I feel that I have been wronged in order to justify its expression. And then once I realize this is what I am doing, I feel wrong again.

Tags anger, Breast Cancer, displaced anger, grief, Marriage

Categories Breast cancer, Marriage, Mindfulness