Mastery of fear

Buckle up, this is a long one. This month marks three years since I started treatment for my stage 3a HER2+ breast cancer. It is confusing to think about my “cancer free” interval, as I had 4.5 months of chemo before my surgery, and at surgery the cancer was all dead, so who knows when exactly I was “cancer free”?! So I count from diagnosis. Just over 3 years.

Fear sucks, but unfortunately is a reality for cancer survivors. The good news is we can learn to overcome our fears, to master our fears, to be courageous, if we just find the right tools.

This summer I had a recurrence scare after some routine follow up imaging showed suspicious nodules in my lung and liver. I had previously had PET/CT, CT scans, and plain chest xrays, but we decided to do an ultrasound of my liver and another plain chest xray as routine follow up this year, just because they are cheper and easier than PET/CT (for which I have to drive 5 hours to Guadalajara).  Interpreting an ultrasound of my liver is difficult, as I have many cysts (which have been previously seen on all of my imaging), but this summer’s ultrasound described two small solid nodules of unclear etiology that had not been seen before. This summer’s chest xray also showed a small solid nodule that had not been seen before. So for anyone who knows anything about cancer, you’ll know these imaging reports scared the shit out of me. Any newly identified solid nodule in a breast cancer survivor is concerning for metastatic disease, meaning the cancer has recurred and spread to those locations. I had bloodwork at the same time, which showed mildly abnormal liver function, but normal breast cancer tumor markers.

At the time I received these results, I was feeling great, practicing yoga every day, seemingly getting stronger and more flexible each month. I just felt nothing that would suggest that anything was wrong. In fact, I had never felt better. Of course, this doesn’t always mean that everything is fine, as you might not “feel” small volume metastatic cancer. But I just really didn’t think it was back. So I talked it over with my doctor, and we decided to just wait 2 months, and then repeat the tests to see what was there. I felt good about this plan. I didn’t want to panic, freak out, and go all the way to Guadalajara for another PET-CT, and cause myself a bunch of unnecessary stress if, in fact, everything was fine, and these were just benign findings, or false positives on these new images. I felt like my mind was clear, calm, and I could definitely wait 2 months. I mean, what’s the worst that could happen? I even though “this sure will be a test of my ability to remain equanimous in the face of stressful situations”! And as morbid as it sounds, we even said “well if the cancer is indeed back, waiting 2 months to start treatment won’t make any difference in the overall situation”. Ugh.

I started into the 2 months of follow up time feeling pretty good. I reminded myself that I had responded so well to chemo, achieving the “complete pathologic response”, which is a good prognostic sign. I reminded myself that the highest risk of recurrence is early in follow up, and that my PET-CT at 2 years had been fine. I felt pretty sure that everything was ok. Pretty sure. But not 100% sure. Eventually, little moments of fear started creeping in. I remembered that it had been a very aggressive and locally advanced cancer at diagnosis. Shit. I remembered patients I had known who had recurred 3 or more years after apparently being disase free. Double shit. Maybe I was just in denial, trying to tell myself that everything was ok? I started getting paranoid about little aches and pains (which I always have, and I relate to yoga or sleeping funny), fearing maybe they meant something bad was actually going on. And then my mind would just start to plummet into awful scenarios of recurrence, and what I would do, how would my loved ones react, etc. If you are a cancer survivor, you know what these fears feel like.

Fortunately, each time I started into one of these fear episodes, I was able to notice it. Awareness is the first step toward change, right? Body and thought awareness practices from yoga helped me to feel the fear swirling as it began.  Then I was able to engage my breath, or a mantra, to calm my mind. This allowed me to come back to the present moment. Was I ok in this very moment? Yes. So why allow fear of some unknown in the future to wreck my here and now? Might I find out some day in the future that my cancer has recurred? I guess so. But today is not that day. So I want to enjoy today to the fullest. I thought about non-attachment, contentment, and surrender (from the yamas and niyamas of the 8 limbs of yoga), and I was able to release my attachment to “knowing” I am free of cancer, to find contentment with the not knowing and with where I am today, and to surrender to the universe, to trust that whatever is meant to happen (even if that is cancer recurrence) is happening for a reason, and is part of my path and my journey. Fighting against it or freaking out about the possibility will not stop it from happening, and will just cause me misery in the meantime. It sounds a little crazy, and it isn’t always easy, but I really do believe that all of our struggles are here in our lives for a reason, to help us learn something or grow in some way. So whatever my life brings, I welcome it openly. In these ways, my yoga practice and yoga philosophy helped me immensely in the 2 months while I waited for my follow up.

The time finally came and I went for follow up in August. The lung nodule had disappeared (who knows what that was or if it was just the appearance of overlapping blood vessels that looked like a nodule), and the liver nodules were unchanged. The radiologist’s impression was that they are likely hemangiomas (benign vascular nodules), as they surely would have grown in the 2 month interval if they were cancerous. Also the follow up blood tests showed the liver tests were normal (probably abnormal previously due to dehydration or too many margaritas). Phew, the relief was immense. Of course, we still need additional follow up to be certain, and I’ll probably have the PET-CT this winter, but for now, it looks like I am cancer free. I’m back to feeling great, not worrying about little aches and pains after vigorous yoga practices, and not thinking about cancer recurrence too much.

Mark Twain said “Courage is resistance to fear, mastery of fear, not the absence of fear”, and I think that is so true. As cancer survivors, and maybe just as humans, I think we are always going to have moments of fear here and there. There is no way to eliminate them completely. But through the practice of yoga (and I emphasize the word practice, because it truly is an ongoing effort, a practice), we can learn to resist, master, and overcome those fears one by one.

I know I am one of many who have had this kind of recurrence scare. I also know I am lucky to be, for now, cancer free. Some get the other kind of news when they go in for follow up. I wish courage, strength, and comfort for those survivors, as they traverse further tests and treatments.

I am grateful for every day. I am open to what each day brings, and I greet it with love instead of fear. I am courageous. I am a survivor.





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