Health, Mental Health and Quality of Life

I went for a run last night; the first one I've been on in 10 days. A week and a half may not seem like a long time, but it's the longest I've gone without running since I finished chemo in 2013. And if you know me, you know that I have two keys to good mental health: running and writing.  (These are also common themes which I've touched on from time to time on Thinking Out Loud.)

But over the last 4-5 weeks, my running has been a bit sparse. I'd been having some minor GI issues that have finally worked themselves out. I'll spare you the details but they were minor enough that they didn't outwardly affect my daily life. Still, they were  persistent enough to get in my head. Not every day, not all the time, but enough to occasionally distract me and take me off my game. In a month overflowing with kids' appointments, lawn work, and busy work schedules, it gave me one more thing to think about when I was debating whether or not to squeeze in a run. 

The bottom line is that it's hard to stay mentally focused when you're physically not well. My chemo regimen was relatively light compared to others, and the burden on my mental state was similarly light. But for those going through long lasting cancer treatment, it's not just the anxiety of the prognosis, but also what the treatment is taking away that weighs on the mind and sinks the mood. Add in a good deal of idle time for the mind to wander and it's a dangerous recipe. 

According to the National Institute for Mental Health, 16 million adults in the US, or just less than seven percent of American adults, had one major depressive episode in 2012. Given that there are about 1.7 million new cancer diagnoses in the U.S. each year (according to the American Cancer Society),  and millions living with cancer, I would imagine that there's a good overlap between the two statistics.

People in and around cancer often talk about quality of life. And that phrase often bothers me because I never can quite parse what it means. But whatever it is that defines quality of life, good mental health has to be part of the definition. 

--michael

Happy Chemoversary

I've had this day circled in my mental calendar for a while now. 

Two years since my last chemo.

Me, two years ago, celebrating
the end of chemo

 The deal with follicular NHL as we all know is that it comes back, sometimes quickly, sometimes years from initial treatment. I'd like to be in that latter category, thank you very much. In fact, I'd be fine to be an outlier. For some cancers, there's a statistical significance to how far out you are from chemo. I'm not sure that applies as much to indolent lymphomas such as fNHL but it still feels good for the visions of chemo to fade further away in the rear view mirror.

And while I'm not much for artificial milestones and there's nothing really differentiating this Sunday from any other (save a big football game in a couple hours),  getting to two years post-chemo and still feeling good -- well it felt like some hill that I needed to climb.

Nothing has changed, except that I now will only see my oncologist  twice a year, instead of quarterly. But having crossed the threshold seemed at least worthy of marking here, and with my most consistent health affirmation -- a nice winter's run along my favorite local route.

That accomplished earlier today, it would be a nice cap to have a Super Bowl victory too. But whatever happens in tonight's game, it's still a good day.

--Michael

Running through a New England Winter

Yesterday was beautiful. That rare February New England day, when two-month high piles of snow start to melt as the thermostat tops 50. A great day to shed the long pants, gloves and hat, and go out for a long run.

I wasn't alone.

I saw many runners enjoying the weather. Some, perhaps lacing up their shoes for the first time in a while; others basking in the reminder that spring is around the corner. But forecasts say we'll be back in single-digit lows within a week. And I'll still be outside running.

Why?

I hate treadmills. Yes, I can run faster on them because there's no wind resistance. Yes, I can watch the Winter Olympics on the dashboard screen. Sometimes, they're a necessity. I was listening to Dana-Farber's Dr. Rosenthal talk about integrative therapies, and as he talked about the benefits of meditation and what meditation was, I realized that for me, running is meditation. And it's hard to meditate when you're surrounded by other people, watching television and there's a loud, pounding accompanying your steps.

But a dislike of treadmills may keep you pounding pavement when it hits 30 or maybe 20 degrees; but something else has to be at work when the wind chills are approaching zero.

For me, I'd be lying to say that there isn't at least a little bit of "real runner-itis" at work. I've been running since discovering at sleepaway camp in Maine that I was pretty good at it. (Note: when I say pretty good, I need to qualify that. Except for one second-place finish in one track event in ninth or tenth grade, I've never won any race, qualified for any marathon or done anything remarkable in 40+ years of running.  But when I'm running through Boston in the bitter cold, I do feel a bit of ego-induced satisfaction -- of proving to myself that I'm a real runner.

In the past that's gotten me out and running in all sorts of weather. But absent the need to train for an April marathon four years ago, in times of extreme cold, I've turned to the treadmill. This year's been different.

I've said before in this space that since my diagnosis and then chemo, running for me helps me prove to myself that I'm alright -- that I'm healthy. This snowy, cold New England winter, though, running for me has become more than  just an act of assertion, it's an act of defiance.

Whatever the universe brings - lymphoma, snow, single-digit temps -- if I can run, I will.

--Michael

Staying Strong

In a few short weeks, it will be a full year since my last round of chemo. It seems like forever. I don't have another scan until September; my blood work looks fine; I remain, despite my tendency to think any ache is lymphoma-linked, symptom free. I am essentially living the same life I was prior to June 30, 2011.

Essentially.

I tried to think the other day of how I felt before I was diagnosed. What a day was like when the thought of cancer was as distant a thought as winning the lottery? I could only fantasize about either -- and the lottery was the better choice. It's been 2 1/2 years and it seems like this is how it's always been -- which doesn't mean I'm always thinking about cancer.  

But when I am thinking about cancer, and in particular, my cancer,  I occasionally think about dying. I think any cancer patient who says they don't is either trying to protect someone or very, very good at optimism. When I do,  it's always the prospect of missing out on things I'm looking forward to that's the saddest. (Ric Elias talks about this in his short Ted Talk, 3 Things I Learned While My Plane Crashed , which is worth a view.) When we're young, we think we're invincible; when we're older, we often think of ourselves as immortal -- that we're always going to be there.  

Even when the prognosis is good, cancer removes any illusion of that immortality. 

It's not that I often think of dying, but the idea of not being here will sometimes invade my thoughts at my weaker moments. It's been said that fighting cancer is as much a mental battle as a physical one. I'm not sure about that. But I do know that when I'm feeling tired, infected with a touch of symptom paranoia, or otherwise run down, it takes effort, real mental effort to keep those negative fantasies at bay. 

It's always tempting to live from appointment to appointment rather than take each day as it comes -- to carpe scan instead of carpe diem. When I find that temptation hard to resist, I resort to the best therapy I know. 

I run. 

I run for the exercise. I run to stay in shape. I run to counterbalance the ice cream I might eat later. I run to infuse energy into my body, to boost my mood, and my productivity. And some days, I crawl out of bed at 4:45 am and take a train into Boston so I can run to affirm my health. 

--Michael

My Quiet Space

Torn between writing about running or not writing, I'm going to write about running. Or at least I'm going to start by writing about running, again. I've found out during these past two months as both my frequency and distance has increased how important running is to my well-being. Yes, the exercise has been great and the shirts that didn't fit so well at the height of steroids and post-chemo carb-loading now fit a bit better. 

What it really comes down to is that running is my quiet space. No email. No social media. No phones. No people. Just me and my music. The cliche often portrayed in commercials, books and movies is the runner's epiphany. Lace up the shoes. Take a few strides and answers to vexing problems crystallize. That never happens. Not to me, at least. 

My mind wanders a lot when I'm running. It thinks about the lyrics of the music playing; it observes the surroundings; it usually grouses a bit about the lack of friendliness of other Boston runners (the runner's courtesy wave is all-but-never acknowledged on my Boston runs, and always acknowledged on my Barrington runs); maybe it bounces a bit from how to phrase an email or what to say to a colleague; it thinks about how to run a baseball practice; perhaps a couple of ideas will float in for a future blog post.   and often, it calculates how far it is to the next turn, the upcoming section of run, how its body feels, and the pace of the run. It's rare that I even think of cancer, or my cancer, unless it's done with a little bit of n attitude. And after my mind's processed all that, I have a mile done and four more to go.  

Then a wonderful thing happens. 

Quiet.  

Because for all the noise pumping through my headphones, running is my quiet space -- my meditation. It's my way of learning about myself. Because once the scattered thoughts have come and gone, and it's just me, my music and my running, my mind turns inward and stops processing tasks, and starts thinking about who I am, how lucky I am to have the life I have, and how I want to live. I almost always end runs feeling inspired and energized, not simply because I've released a few endorphins and burned some calories, but because of the quiet space I was able to inhabit for the last few miles. 

 

 

The More Things Change...

I've had the whole day to write but  it's 7:15 and these are the first words to eke out of my mind. I was going to write about my five-mile run yesterday -- the first time in more than 6 months that I've gotten back up to the five-mile mark. But frankly, this is a cancer blog, not a running blog and I've been covering that ground a lot lately. That said - the run was great and followed it with just shy of 4 miles today. So take that cancer.

It's funny, but about a year ago, I was debating going to the lymphoma conference and wondering why I didn't write more often.

The more things change, the more they remain the same.

Although of course, a lot has changed in a year. In chronological order, in the last 12 months I made this blog public, went from watch and wait to active treatment, turned 50, and made it through six months of chemo.  That qualifies for an eventful year.

But I'm here on the other side of chemo feeling in some ways very similar to how I felt pre-chemo. Feeling fine (knock wood) and watching and waiting. The challenge, to me,  is not to get too hung up on the watching, and spend plenty of time on the waiting. Too much watching can be an obsessive,  anxiety producing pasttime. And not enough waiting means  living in three-month intervals, waiting for the next clean bill of health so I can say 3-months clear, 6-months clear, until what? Until I've made it past the median progression-free survival number? And then what? In the meantime, living from visit to visit tends to speed up life when I'd rather do the opposite.

I've written before about living in the moment, and enjoying those moments as they happen. It's easy to say, but hard to do.

Of course, beyond the treatment, there is one thing different from how I felt a year ago: back then  I decided I didn't feel enough like a cancer patient to go to a lymphoma conference. This year, I'm going. 

-- michael