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

The Bright Light of Cancer

It seems like a lot of my cancer blogging friends are stepping back. Some that were blogging regularly are doing so less so; others have turned the spotlight away from cancer, or even health, and others still, have flipped the light off and closed the door behind them.

I understand it.

I've written about how often I should blog, and if you closely examine the content of the blog over the past month or so, I seem to have veered slightly away from writing about  my thought process and mental health as it relates to cancer. My last post didn't even mention cancer or lymphoma -- but then again, if you examine the early posts, I stayed away from the big C word. Denial? Fear? It wasn't accidental. As a writer, I usually think carefully about word choice so it couldn't be coincidence that a blog called,Thinking Out Loud: A Cancer Blog, didn't mention the word cancer. Most often, I would use the term, my diagnosis.

I'm comfortable now talking about my lymphoma, my cancer. But it comes at a time when my cancer doesn't have much to say. The chronology of a cancer crisis progresses like a nova. The intense light builds and builds, bursting to the forefront of your identity with such blinding brightness, that it obscures all other elements.

All you can see -- and all, you fear anyone can see  -- is that white hot light of fire. The rest of your identity exists; it just seems invisible to those who can see that explosive brightness. This is why so many struggle with who to tell, and who not to tell. If I tell this person I have cancer, will they still be able to see me.  Or will they just see the cancer?

But here's the thing about novas: they slowly return to their original state. Their brightness fades, and the rest of your identity seemingly shines more clearly. It's not that I have less to say about cancer, it's just that the bright light of cancer has faded. For some cancers -- those with legitimate cures, it may fade to black, leaving only a residue of light. For the more chronic cancers, the light will stay softly on in the background, pulsing with activity from time to time. 

As the light grows stronger, it will be reflected here. And when we have found a definitive cure for follicular lymphoma -- not a push-it-into-the-background-and-wait-for-it-to-return treatment, but a god's honest, it's-not-coming-back cure, then perhaps both in my identity, and in this blog, cancer will fade to black.

--Michael 

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

Processing

Dorothy Parker may have written to have written, but I write to process information.

At least that's one of the reasons. When I started blogging 18 months ago, it was to get the ideas out of my head and onto paper. The ideas, I thought, could do less harm there. I also enjoy the craft of writing - of stringing words and sentences together. Rearranging them so that sentences fit into sentences, into paragraphs, into a seamless, smooth surface. What I discovered along the way of 100 or so posts is that writing is also how I process information. It's how I digest what's been said, and figure out in my brain what it means to me, and how I'll deal with it. Even when what I'm presenting seems straightforward, it's never about reporting information to me; it's always about processing.

Which brings me to Monday night's post. I had the hardest time writing it because it was just information, and it was just information because I didn't know how to process what I heard. It was good news - scans looked great; bloodwork looked great. If we were to do PET/CT which isn't always necessary, we'd likely find No Evidence of Disease. It was good news!  But I was blocked. And the more I was blocked, the less I could process; the less I could process, the more I was blocked.

Dog chase tail. 

Then to confound things, my inability to write - to celebrate through words, to celebrate with this small handful of people who have been my crutch and my support, well that just pissed me off. And then, because I couldn't write about that -- about the fact that I was angry and frustrated that I couldn't use my writing to process it -- well that just made me question whether I should be celebrating. That's just crazy. My inability to write started to affect how I felt.

Dog chase tail.

I wouldn't be the first person to say that as lousy as cancer is, it brings blessings in disguise. A fellow blogger uses that very title in her blog. To me, the blessing has never been about appreciating moments more, I've always been grateful for the life I lead, even if I might be just a bit more aware of the beauty in the mundane these days. To me the two greatest gifts cancer's given me are an ability to do my job better, and a chance to do what I love to do: write.

There are many stories of writers who can trace the seeds of their writing career to their childhood  --to stories written for their elementary school magazine or a teenage writing contest or such. Not me. I had a love and aptitude for numbers as a kid. I was going to be an accountant. Truth. Then somewhere, in college, I think, I started writing. Crappy poems. Amateur short stories. Oddball pieces for fringe magazines and newsletters. But they got me to a point where I was 23 and  sitting by myself on English Beach in Vancouver, B.C., at the end of a day that I don't remember, writing. And  I decided. This is what I should do. 

More than 25 years later, thanks to this blog, I'm writing today more than ever, and like the news I got yesterday, that's a good thing.

--Michael