Tag Archives: Cancer

Anxiety – a monster under the bed?

We can’t escape it. The worrying thoughts. Sometimes a pounding heart or sweaty palms. At times the sense of unease. Anxiety in its various forms can be present in all of us at different times. It is called many names. Fear, panic, phobia, stress, freaking out, concern, etc. At times it arrives because of a specific event (like an examination or doctor’s appointment). For others it may be the sight of an unwanted visitor. Good morning Incy Wincy Spider!

None of us escape the experience of anxiety. It is in essence hotwired into us. Hotwired neurologically and like electricity runs through our central nervous system. But why do we have anxiety? This uncomfortable and even disabling experience. Why is it often part of our daily lives? Not everyone will agree on “daily “, but I find that the majority of clients presents with a higher or lower degree of anxiety. This is very often the case when anxiety was not their initial complaint or concern. I am thus not surprised when a referral to me is due to depression or other challenges , but it becomes clear that anxiety is part of the package.

When it comes to emotional obstacles, a major challenge can be fighting against what we can not see or what we believe “is part of whom I am”. In essence the fight can then turn against one self. Me versus I. Instead of me against anxiety. To see anxiety as the enemy is not beneficial and can be visualised (imaginative or symbolised by a real object) as the problem the requires management. And the starting point? At the beginning. Understanding how anxiety operates and why we experience it.

Step 1. Feelings of anxiety start with a trigger or catalyst. This may be a smell, seeing an external object or by internal feelings . The amygdala jumps into action by preparing us physically and mentally into a fight or flight mode. This response is triggered by the release of adrenaline into the bloodstream via the kidneys. As a result our blood pressure and blood sugar rises, muscles are fueled with energy and we focus on what may be the potential danger. This may stifle some into a passive state; others are thrown into chaotic action, while others become extremely focussed and structured.

The Shadow ManStep 2. To identify the threat or potential danger. The importance of this that we may be (1) confronted by a real danger or problem, (2) that we responded incorrectly to an external or internal stimulus or (3) that when nothing happens, uncertainty may be appear to be a threat. This step is within the context of anxiety being a survival mechanism. If not for anxiety, we would not have survived as a human beings over centuries. However, when exposed to anxiety on a regular basis or growing up in an environment where anxiety flourished, it might have become behavioural patterns and even part daily routines.

Step 3. Ask yourself, “What purpose does anxiety serve in my life?” Does anxiety enhance my experiences of love, beauty, creativeness and (importantly) logical thoughts. Does it impede in the pleasure I may gain from a loving relationship, my sleep or even my ability to complete my studies or a piece of art? What does anxiety steal from me?

Step 4. Finding ammunition to manage anxiety. Before you fire away, know we cannot rid ourselves of anxiety . We all have times when anxiety visits and times when it serves an important function. However, consider the following:

  • How many of your worries become true? If you write down your weekly worries. Say you start at the floor, write them down one for one till you reach the ceiling. How many did repeat? Then tick each one that became true. How many ticks? Interesting.
  • Stay in the here and now, the present. Anxiety often let us dwell on decisions we made (“Did I do the right thing?”, “What did they think …?”) or focus on the uncertainties of the future (so many “What if?” questions).
  • Know that your experience of anxiety does not imply something is wrong with you. Anxiety visit people from all ages, religions, cultural backgrounds. You are one of us if you experience anxiety. You are not alone. You are not the problem. Anxiety is.
  • Do you ever worry that someone will knock on your door and say, “Congratulations, you have won a wonderful holiday!” No, anxiety does not focus on possible positive outcomes. It tells us the potential bad stuff, what may go wrong and the worst possible scenarios.
  • Know that physical sensations are anxiety gearing you up for action. Your dry mouth, hairs on the back of your neck rising up, having cold feet and pins and needled in your fingers, butterflies on your stomach, shallow breathing and increased heart rate are all part of the fight or flight package. You can use it if you are under threat. But if all is fine, know that it is just anxiety being unpleasant. Know YOU WILL NOT DIE FROM THIS.
  • Breath in. Breath out. Slowly and deeply. Give your body and your brain oxygen. Breath in. Breath out.

Step 5. If you find anxiety overwhelming, find someone to talk to. This may be a friend, a family member, someone you trust (e.g. religious affiliation) or professional. So often anxiety grows on us as we keep it private. But bottling it up just let the temperature rise. Let it out, let it go. The monster under your bed is not real. It is anxiety trying to scare you.

 

 

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MRI Brain Scan: a crash-bang-bang course

It’s the 23rd. It is a positive start”, I think when the receptionist said the date. 23 is my lucky number. I completed most of the paperwork the previous week when I dropped off my oncologist’s referral letter. A few more dotted lines call for my signature. I don’t know how many MRI scans I have had; today’s might be 6th. However, the last one in March was the most important. The one labelled, “all clear”.

How do I approach a brain scan? Like everyone, I suppose I my own ways. Each person will bring specific fears, unique routine and mental preparation before facing the tunnel. Earlier today my rituals consisted of the things under my control. Having a shave, dressing in my favourite light orange and white shirt, wearing comfortable jeans, putting on my trial running shoes that make me feel grounded, a call to confirm the appointment time and leaving enough time to arrive early. Nothing out of the ordinary, but it is the ordinary and familiarity that bring comfort.

I arrive at the hospital 15 minutes early. I don’t carry anxious thoughts with me, never been a great advocate of worry. But I sense the tension in my back and shoulders. It’s not possible to ditch all the anxiety. It tends to sneak in when you are not looking. Anneén arrives before I reach the main entrance. I told her she did not have to come, but it is a great comfort to have her with me. Knowing she will wait in the reception area when it’s all done. It is oddly quiet when we slowly criss-cross through the hospital passages. Most of it was renovated recently and signs warning of wet paint still serve as decorations. “They could have done with a bit of colour” we agree. No one else waits in the reception area. The school and university holidays provide a nice change from the usual hustle and bustle.

When called, I know the drill. I leave my outer layers of safety behind and emerge from the change locker in a faded peach colour garment. A further breakdown of any aesthetic possibility comes in the form of my long black running socks sticking out from underneath. Comfort? Yes. Sexy? Definitely not! I wait for a few minutes underneath signs and arrows that directs towards different scan options. A cleaner slowly sweeps the floor area surrounding me. I feel a need to focus on something. Unfortunately the small Beavers and Butthead cartoon on the notice board is too small to make out the writing.

Luckily the bad joke requires little time as it is 8:45 and the MRI scanner waits. Lying down on the flat surface is the easy part and fairly comfortable. The radiographer knows about my previous scan experiences, so she shiftily hands me the earplugs (to reduce the noise) and place two sheets of white foamy stuff both sides of my face. She moves my head slightly to the left and gently pressed down on my chin to position my head correctly. The small rubber bubble is placed into my hand, in case I need to call for help. It provides some security, as I used it on a previous occasion when the claustrophobia got to me. Finally she covers me with a blanket for both physical and emotional warmth. All I need is music to relax, but it is not available as I am not allowed any metal (not the musical type) or earphones in the tunnel due to the strong magnetic fields.

You can open your eyes if you want to”, she says as I slide into the tunnel. “There is no way”, I replied louder in my head than in words. I made that mistake once before. I don’t like narrow spaces. I admit that I don’t like being out of control either – especially about my physical space. I can feel my elbows being slightly pushed inwards by the sides of the MRI’s tunnel. For a moment I am aware that the blanket is slightly pulled back on the sides due to inwards movement. “I am covered like corpse”. I don’t know where the thought came from, but I was ready for it. “I am here because I am alive”, I counter-argue. “I am here being I want to remain healthy and value life”. And so my process in my head starts to manage the crowded space and mechanical noise.

  • I start with thoughts. Focussing on being alive. The people who matters for me. I am doing this for them and me. What I know. For example, I had no symptoms or strange behaviour (as far as I know at least!). What is important (staying healthy)
  • Visualise memories and beautiful images. Seeing my daughters jump on the “bungee trampolines” the previous day. Looking out over the sun covered vineyards with snow covered mountain peaks behind.
  • Letting go of these images and thoughts and let them flow away like thick honey.
  • Slowing down my breathing. Being aware of my breath, rather than the lack of space around me.
  • Comparing the mechanical noises with sounds I know. I hear a large mechanical bee, a dentist drill, an electrical mosquito, a loud air-pressured drill. A hammer against a water pipe.
  • Physical sensation (such as an itch that I can scratch) indicates to me that I am alive.

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It does not feel like “about 25 minutes”, but after a short silence the radiographer returns and injects my arm with contrast dye. This makes certain tissues and blood vessels show up with greater detail on the scan. I move back inside with less tension for the last 15 minutes. I allow my senses more freedom to explore the experience. Mumford and Sons are still playing “After the Storm” in my mind when I exit the scanner’s tunnel. I am set free.

2013-09-23 12.11.21_resizedIt is 3 hours later and we are sitting at the neurosurgeon’s office. I am aware of the results CD in my hand. The CD is light, but the engraved information carries a different weight. Martin greets us as he walked passed. He needs to quickly go to the ward, but will be with us on time. On his return, Martin opens the scan result on his computer. There two brains, both mine, on display. One from the March scan. The other from this morning. They look similar. Martin shows the left frontal area where the operation took place. I dark area indicates where the tumour and some brain tissue were removed. Nothing else shows up. The scan is almost identical to that done in March. I am clean. No cancer growth or tumour cells are visible.

Once more I am set free.

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The last chemo tablet standing

And there it was. One out of the last 4 Temadol tablets to go. Even though my mind knew the relief to have reached this point, my body was not at the point where it felt it. The milestone can be celebrated on another day. But after the initial 30 days of chemo and radiotherapy and now, with one tablet to go, the past 6 months have been about picking myself up and then going into survival mode for 5 to 7 days, picking myself up again. Only one of today’s 4 left to go.

 

Thinking back, the running helped. In between the treatment stints, putting running shoes on and getting into running mode cleared my mind and my body felt stronger after been knocked down after every 5 day chemo round. I know that people respond differently to chemo. My experience was overwhelming fatigue. I felt the energy draining away and I had to work hard after each “day 4” to get going again. But I have been able to keep pushing myself. Going to work helped. Seeing my colleagues, meeting with clients and knowing when to take it slow helped. Grateful for the odd public holiday, like being able to stay at home yesterday on Worker’s Day to rest properly.

Most of all I am grateful to Anneén who took on so much more on her shoulders when I was down and almost out, when I could not be there for her and our girls. In those times when tiredness dragged me down, Anneén was strong for us. We celebrated when my last MRI scan came back clean and I celebrate her carrying us carrying us through tough and uncertain times. Thanks babes!

One last tablet.

Off you go.

Go do your dark magic.

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Incidents and Random Events (For Graham)

Ashburton Dads' Football ClubIt was a first outing to the Old Vic in Ashburton. I have only recently met Richard through his wife. She was working in the same NHS trust as me and as the 6 Nations started, it seemed like the ideal place to watch a bit of rugby. Wales played. I can’t remember against whom, possibly England or France. It was the start of the 2009 season and the Welsh were hungry to retain the title they won the previous year.

Although the details are slightly blurred, somewhere during the evening, we met Eilir, Stuart and Stuart’s dad. I wish I could say that the conversations were deeply intellectual, but I must confess that by that time voices were already harsh in the attempts to stay audible over the pub’s noise in between encouraging the team of your choice. I backed the Welsh, my adopted northern hemisphere team. My choice was before finding out that Eilir and Stuart were backing the boys in red. Although thinking back, it would have been obvious given their vocal support that was fuelled on by the Otter Ale. During half-time or possibly afterwards we discussed life in Devon and how my family and I ended up in the glorious part of South-West England. It was Stuart who in his inclusive manner invited us to join their Thursday Football group. Famously among those in the know as “The Ashburton Dad’s Football Club”.

I must admit that it took some courage to take on their offer. The idea was attractive. In the world of mental health, “boy time” is often limited and my profession tends to dwell on the emotional, the intuitive and the relational. But I managed to get some “kit” and some courage. At that point I have yet not admitted that my prior football experience consisted of about 60 minutes of chasing a football. Once.  I have played rugby union. I have played cricket and tennis (both badly) and have attempted several other activities that involved round shaped objects. But more often than not, I discovered that I had the passion, while the natural talent and skill were lacking. But then, why should that come in the way of a good time!

Game TimeI managed to find the pitch on my first venture out. It was cold and rainy – typical. I was probably one of the early arrivals. Over-eager; as always. Nervous to arrive early; as always. The first person I met was Graham. Slightly over-conscious I introduced myself and made reference to Eilir and Stuart’s invitation. It was quite easy to speak to Graham. Hearing where I was from, he referred to his early years in Swaziland and that their family spend time in the northern parts of South Africa. The next hour involved middle aged men running about on the pitch, several claims of illegal play while I tried to gain to decipher what is allowed and what not. Dave quickly pointed out (aka shouting at me) that diving tackles were not part of the game, while it became clear from Tony’s game plan that the off side rule did not apply. It was great. I was a boy again among two teams of slightly overweight and ageing boys. And that was prior to the philosophical discussion back at the Old Vic afterwards.

And so it continued. Relationships grew. Often taking the mickey was a significant component of post match discussions while we enjoyed a few Otter Ales, some warm chips supplied by Nick and Gemma at the Old Vic and while on tour to Cardiff and Bath. In between the football, ale, laughs and scheming on changing the world, there were moments of seriousness. One point of reference was Grahams’ treatment for stomach cancer a few years before. But this did not deter from pulling his leg and his brush with death.

When our family returned from England, I knew that I would miss playing football every Thursday night. Well, saying football, I mean having a roaring time and occasionally running into a few guys (apologies to Joe, Marco, Nick). And defending like hell. Thursday night football became an integral part of my routine and from the first game that left me unable to climb stairs to becoming more fit and competitive over time. I missed it and was grateful for the kind farewell wishes after my last game and well-wishes on my transfer to the “African Ankle-bitters” (!). But a year after our return I heard that Graham became ill again. The cancer returned.

As I mentioned before, the post-football banter was mostly light hearted and full of jest. But underlying was a caring whenever an ADFC member was in need of it. So with Graham’s return to treatment, it came as no surprise that the football guys were planning to run the Rotterdam Marathon in support of Graham and his fight against Cancer. I could not be left out and declared my willingness to run the SAD half-marathon and a local trail run. My training went well. I noted from the http://www.just-dump-it.com/ site that my colleagues up north were training and received information on the finishing of the marathon on the 2nd of April 2012 and how they raised 4400 UK pounds for the Rowcroft Hospice.

But Graham died. He could not go to Rotterdam with the boys and passed away on the 25th of April 2012. It was while thinking about him that I completed my half marathon in Wellington South Africa on the 1st of May 2012. It is celebrating Graham’s life tonight and raising a drink a glass of red wine while the AFDC is raising a glass to him in Ashburton. It is looking at the picture of flowers that was put on his grave today and knowing that time is precious even though we are all fragile.

This one is for you Graham. Saluté!

Graham ADFC

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How Bad News Flows

Just a ringing telephone.
Just my mother’s voice on the other side.
Just another conversation about the week with a bit of this and bits of that.
Just good to speak to her, the same spread of topics. “How is everyone?
It was fine just like that.

But bad news infiltrates the normal flow of things. Unexpectedly. Unwanted. “Did I hear that Laurie has been diagnosed with lung cancer?” Out of the blue, into the cold.

Laurie was a classmate many years ago, a good friend and never a smoker. Despite little contact over the eight years while we lived abroad, he remains a dear friend. And I hate phrases like “good friend” being allowed in the same sentence as “bad news”. Even more when the bad news shadow push towards someone who lives in service of others and support their lives towards new meanings. Like my friend Laurie.But sometimes it merges into the same linguistic stream, creating a new reality that follows the telephone’s ring. In a few seconds the past is shattered with a new present.

It reminds of what Douglas Adams wrote in Mostly Harmless:

One of the problems has to do with the speed of light and the difficulties involved in trying to exceed it. You can’t. Nothing travels faster than the speed of light with the possible exception of bad news, which obeys its own special laws”

Bad news with its own special laws bends the rules and does not read the policy document. Like an outlaw, a deceitful prophet, or the fraudulent official. Bad news carries its own load of heartache and pop songs. Maybe a positive take on it, is that it can override the previous bad news edition. It makes the mouse we caught in our bedroom on Monday night, the power failure Wednesday and the 15 cm drop in swimming pool water on Friday appear like an eventful week, but its only humorous samples to be served at a next social event. Nothing more. But a friend’s diagnosis touches deeper. It wakes the existential me that wants good will, for good to triumph over evil, even world peace. It stirs those emotional places that I visit after dark, the memories where tears and fears frequent, and the heartaches that left scars.

British Library Gate ShadowBut the bad news shadow man can serve other functions. It waves a flag with a red question mark. Where am I? What is my focus? Who is important in my life? What am I suppose to do where I am now? It wakes us from our slumber and pokes us in the side. It raises the shadows that we have forgotten to confront. It is not the niceties of life that gets us through these times. It asks of us, like Job, what remains when I am stripped of everything?

Bad news in essence presents the question of meaning.

Bad news is not about what we have or what possession we might have lost. It does not deal with the fantasy of acquisition or our standing in the world. It takes us inwards, towards facing the mirror with our history and present portrayed in full detail and full colour. It takes us towards our relationship with all the parts of ourselves that developed throughout our journey through different times and places. It takes us towards what we love and loath about whom we are.

And it takes us outwards towards those whom we love. Those for whom we hope that they will take their cancer, their loss, their heartache, their heart attack, their unfaithful partner and that it will confront them with the totality of whom they are. Wake up the shadows that they have to confront, bring them closer to the meanings they have to find for their life. Be that psychological, spiritual, artistic, humanitarian, existential or within whatever framework you define your journeys. It requires the relinquishment of what is unnecessary, what holds us back and what allow the shadows to anchor us in a false reality. It might be status, it might be the drive for success, or it might be materialistic. Or it might be to give up the hope that the world is manageable and predictable. We run into bad news and it breaks our hearts. It takes the solid earth from under our feet and grabs the soft pillow from under our sleeping heads.

Being lucky might not mean the bad news will go away or fit into our fantasy that everything will be all right. Being lucky might mean that we meet ourselves outside the constraints placed upon us by our parents, our teachers, our culture or our fantasies about how life should be. Being lucky means becoming authentic, facing our shadows and watering our inner beauty. It might take us to showing love to ourselves and those we love. Then, to quote James Hollis*, we learn “that life is much riskier, more powerful, more mysterious than we had ever thought possible” and that the “world is more magical, less predictable, more autonomous, less controllable, more varied, less simple, more infinite, less knowable, more wonderfully troubling than we could have imagined being able to tolerate when we were young”.

*From “Finding Meaning in the Second Half of Life

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