When my MRI appointment came onto the scene in September my anxiety reached near epic proportions. It is stunning to me that I could be more, much more, anxious waiting for a routine check up than I was at nearly any time during my year of treatments in 2014. I am coming to recognize that anxiety is in part simply a communication between the nonverbal brain and the verbal brain. I have felt a bit hijacked by those communications to be honest. It was a different experience than my Netflix and ice-cream response to the stressors of early summer. And yet I recognize that I was awash in feelings that I have experienced before. This hasn’t been the first time riding the angst bull.
But then, through October my anxiety continued to be omni-present. Anxiety that began to arise seemingly out of nowhere. Anxiety that didn’t seem to have any clear source. My meditation practice totally fell apart in October which didn’t help. Central to my plan to address my Cancering is a commitment to minimize stress, and to address how I respond to it, i.e. practicing mindfulness and exercising. When anxiety starts interfering with that plan, there is a problem.
In the past I have used other words: stressed, sad, nervous, worried, depressed, overwhelmed, overwrought… Since learning more about the physiological mechanisms for anxiety I can see that all of those emotions are really different faces for anxiety.
Perhaps unsurprisingly anxiety is very common amongst those who are traveling through life post cancer diagnosis. But, lately it has seemed to be a near constant companion for me. And by lately I probably really mean this year. My question is why now? Why not as much last year? Or during my year of treatments? After alI I had the same ACE score* then as now. Though I recognized that in many ways anxiety has been present in my life throughout my life, usually it was in response to stressful circumstances. Why has it begun to rise up higher and higher to become omnipresent this year? What am I missing? Am I simply unraveling some long dormant angst of past troubles? Have politics invaded my sense of safety?
I did a little qualitative review of my writing, and therefor my life. I began to see that my happiness has been on a bit of a downward trend since the end of my treatments in the end of 2014. While in September I equated it to Scan-anxiety, that doesn’t explain what was up with October, after all my tests came back clear. So why was I so often feeling a nameless dread? Or the sudden breathless waves of doom out of nowhere?
My life is not bad- but the pall of frequent bouts of angst have been making it difficult to reframe – and to make the choices that support my happiness. I know myself to be a person who is generally wired for optimism – so what gives?
Reading that certain side effects of Tamoxifen can increase over time confirmed one of my suspicions. At this point I am fairly certain that the hormone disruption effects of Tamoxifen are a core contributor to my anxiety problem this year. If you have been reading for awhile you know that I have been largely unenthusiastic about taking tamoxifen since the get go. It is possible that I am again demonizing it. I will write more about my choice to stop taking it, but for now I am definitely noticing a significant improvement in my spirits. Since I just returned from vacation it may be unfair to equate the reduced anxiety with the end of Tamoxifen. I know that there is a difference between causation and correlation. Time may reveal that I am simply feeling better post vacation. However if my mood continues to stabilize, even while back in my normal everyday life, in the dark winter months of the coastal northwest, than it is probably likely related to the other recent change, namely stoping Tamoxifen. (For damn sure the ongoing political situation does not inspire joyfulness.)
Cancer treatments involve a certain amount of trauma that needs to be processed and released from the body. Also because the body can theoretically renew its cancering activities at any time, life post treatments involves a fair bit of inbuilt opportunities for anxiety. (Enter Scan-Anxiety) Regardless of the source of anxiety it is a hijack of happiness. It is real, and there is no way to logic yourself out of it.
While on my trip to NM I finished listening to the excellent book, The Body Keeps the Score, by Dr. Bessel van der Kolk M.D. It is definitely a commitment – clocking in at over 17 hours. It is dense with data and rich with stories that deeply showcase the impact of trauma on the human experience, especially childhood trauma. I am eager to explore some of the treatments he describes in the second part of the book.
What I learned in Bessel’s book is that our brains change throughout our lives. And that our physiology changes in response to trauma. Specifically the way we assess risk, and the ways we process sensory input. What we have learned from the ACE study is that early traumatic experiences in childhood can Hotwire the stress responce in such ways that hugely impacts not only your experience with anxiety, but also every other aspect of your mental and physical health. Like Dr. Bernie Seigle, Dr. van der Kolk identifies early childhood trauma as the biggest public health crisis worldwide, period. It directly relates to not only individual health and wellbeing, it is directly related to the antisocial behaviors that fill our boardrooms and prisons perpetuating more pain and suffering, childhood trauma has huge costs to our society. A EU study showed that spending $1 on early childhood intervention saves $7, because of averted health and legal costs. By addressing the wellbeing of children we address the wellbeing of our entire society.
The ACE study was done with a population that was generally economically stable, predominantly white and privileged with a college level education. It drew strong connections between childhood trauma and adult health. The lessons learned can be applied more broadly because regardless of race or any other division we may draw between people, we all share the same needs and our brains and bodies use the same processors. So while there are individual adaptations to stress and trauma, there are identifiable common impacts that are predictable. I also appreciate that the ACE study illuminates that childhood trauma can and does cross socio economic and racial boundaries. Addressing it is important for all of us.
For my situation it is worth also considering the piece of being born on the sensitive end of the continuum. Which may or may not be connected to maternal stress while I was developing, or even while my mother was developing within my grandmother. (Enter Epigenetic studies.) Regardless I suspect that my responce to Tamoxifen is related to my generally highly sensative physiology. Extreme responce to stimulus, including substances, is just a reality of my existence. Remember me on steroids? Remember my blood pressure bottom out after my port placement procedure that “earned” me an overnight hospital stay? I am generally immensely grateful for being sensitive, and at the same time I recognize that there are sometimes situations in which it makes me more vulnerable to harm. Like a very pale blond person may need to take greater care with sun exposure than I as a more melenin rich individual might.
I know that I am in many ways a canary in the coal mine. I also know that ultimately I am responsible for everything in my life. Because my body is giving me feedback, that puts me in the self care driver’s seat. Anxiety is a core survival mechanisms trying to save me from a perceived threat. It is probable that the lottery of my birth and early childhood experiences may combine to make those mechanisms more responsive than is strictly necessary in some situations. It is also true that regardless of outside stimulus, my internal chemistry is very sensative to pharmaceuticals. This same sensitivity may explain my somewhat miraculous responce to chemo and targeted therapies.
So the whole story of anxiety is related to perceived threats from within and without. It is the deeper survival brain talking to get the attention of the thinking brain.Those who are born sensitive and those who have experienced trauma may be predisposed to problematic anxiety. Depression and Anxiety are known side effects of Tamoxifen. So, my situation is basically a triple whammy set up for a freakout.
For right now I am going to continue my self care efforts to address that over active amygdala of mine. That includes giving myself some space from Tamoxifen. I will likely be writing a letter to my oncologist, since I am not scheduled to see him until March. Because anxiety is not just uncomfortable, it also has impact on my cells. The kind of impacts I am trying to avoid in order to do my due diligence to prevent a recurrence of cancering. (Remember how stress supports cancering?) For right now I am enjoying not being a woman on the verge of a nervous brake down for the first time in months.
*ACE Study- Adverse Childhood Experiences was a study done by the CDC and Kaiser that looked at the health records of thousands of Kaiser patients and also surveyed them about their childhood. Choosing 10 adverse experiences to tabulate. People with a score of 4 or higher are significantly more likely to experience all the things that make life suck; from cancer to incarceration, diabetes or addiction. Key response mechanisms to trauma place the body on long term high alert – and as we know stress kills.
P.S. If you have never seen this film, well it is time you do.
All pictures in this post other than the book cover were scavenged from the inter webs, and are from the film.