Tag: Anxiety

I’m coming up on my two year anniversary and I am nervous.

Ok, so, on June 3rd of this year, it will be two years since I was discharged from the hospital after my stem cell transplant for my second cancer. This is about how far I got when I thought I was in the clear from my first cancer, so I am nervous. I just have to make it beyond this point to be able to believe that my cancer free status will stick,

I decided to go big with the second one…brain cancer! Primary CNS lymphoma. Thank the lord it was a treatable one, but still scary and awful nonetheless. I thought to myself at the time what the heck? Two cancers in four years! Something had to be messed up in my baseline so I thought a do over was what was needed. I have to admit I didn’t fully understand what a grueling and terrifying process that was going to be. Let me explain. First, they have to determine that your cancer is fully treated and in remission. That in and of itself is not easy task with months and months of inpatient chemo. Then, you get not long enough of a break before launching into the stem cell process.

The stem cell process needs to be done within a certain time window as to not allow the freshly treated cancer to return. You need to first inject yourself with what’s called granulocyte colony stimulating factor to get you white blood cells/stem cells to rocket themselves into the millions! Then, you have a triple lumen inserted into your chest that you get to mess around with for a long time to make the harvesting process easier. Then you spend the majority of a day getting harvested through that port. It’s kind of like a reverse plasma pheresis machine that is drawing them out of you for hours. I think I broke records that day with how many I was able to donate to myself and how quickly they came out. I think I was only there for about six hours as opposed to the normal 8 or 10 or 12. I think I overshot the donation mark by several million.

Then, you get another little break and then it’s into the hospital you go. You have to stay anywhere from ten days to a full month. Here is where the real danger begins. The goal of this hospitalization is to blast you with chemo until your white cell numbers are so low that they need to be manually counted! This kind of chemo is so fierce it will have you having crazy diarrhea and nausea and having to shower ever two hours so your skin does not peel off. It is real cannon ball type stuff. It drops your hemoglobin and platelets down to transfusion levels as well. Then, here is where the timing gets really tricky. They need to plan your antibiotics actually BEFORE your immune system bottoms out entirely. Otherwise, you start getting all those terrible infections that a normal immune system would fight against.

Unfortunately, I was not so lucky. My antibiotics were started a little late in my opinion and I got three different infections. I was septic, somewhat out of my head. I had a fever. I had rigors, which are the kind of shakes that literally make it hard to talk or move or do anything. They are very scary. You have to do some really strong narcotics to even make a dent in them. Also, when you have all those infections, you are not allowed to leave your room to do the walking necessary to further stimulate your immune system to take the new cells and regenerate. You are kind of defeated at both ends. That just added to the frustration and fear because I was very motivated to help myself in my own recovery and that got in the way of that.

But, even so, I was able to get out of that hospital in ten days anyway! I think it was a combination of all the prayers, baseline decent health, and force of my own inner strength. I am so so grateful for all of that. There is a part of me to this day that would like to be a part of educating the hospital staff further so something like this doesn’t happened to someone else. Unfortunately, no one was up for that education so those attempts went nowhere.

Overall, I am extremely grateful to even be alive to be writing this for you. There is nothing better than getting to open your eyes in your own bed next to your husband and hanging out with your kids and pets. Nothing. I already had a great appreciation for everything around me but now it is magnified even further. So, my final thoughts are to concentrate on my upcoming anniversary with as little fear as possible,and try to embrace all my future possibilities. Cheers to everyone’s good health and embracing what you have!

Have a great day and a Happy Easter!

Dr. Katz

The next follow up scan is less than a month away. Here comes the apparently mandatory but super unpleasant and unnecessary freaking out.

Here we go again. Another scan is coming up. How many times have I done this? well, a lot. And every single time I start to notice the feeling of unecessary fear creeping up on me. Every twinge panics me. Every tingle freaks me out. Every sense of unexpected weakness scares me.

Seriously? Enough already. I know it’s nonsense. I actually know what it is and can, if I reach back really hard to life before cancer, I can recall feeling these exact same things and they were absolutely NOTHING to worry about. How I miss those days. Granted, I do pretty well most of the time now over six months out, but those close to the next scan times are tricky. Despite all the therapy in the world and all the work put into calming, I still get nervous and icky. So, I sit myself down and purge it all out by writing to all of you. Somewhere in my head I am telling myself that I can turn my feelings and strategies into some kind of validation, encouragement or hope for those of you out there that might be in the same situation. I hear you guys. This post cancer and scan ptsd stuff is real. Make sure that you are taking care of yourself. Make sure that you are taking a step back and allowing yourself some time to acclimate. Make sure you are taking the time you need to try to heal, no matter how long it takes. There is no set timeline. Everyone is different with different levels of strength and resilience. We will all get there, to that station of calm and peace, at least sometimes. Other times, we just have to try our best. It’s all we can do.

Dr. Katz

Hey there doctors! Guess what? It’s actually a good thing when you have a knowledgeable patient interested in their health care!

It has come to my attention after being a patient A LOT lately, that for some doctors, having a patient who is knowledgeable, dares to ask a question, and is genuinely invested in their own healthcare is some kind of terrifying threat.

Huh? Why? Can anyone tell me why? To me, this makes no sense whatsoever. When I get that patient who asks questions and truly gives a crap about their own health care and wants to be involved, I personally feel like I hit the lottery! I am like O Happy Day! Let’s get you healed and healthier together. Let’s help make you the captain of your own healthcare team. Let’s surge you on to the path to wellness together!

The chances of success in this type of scenario are about a 100 times the chances if it’s not. When you have a patient that is willing to put the work in, is interested enough to ask the questions instead of just blindly following without understanding, that is like striking gold. That is awesome! That is the goal we should be trying to achieve! I just don’t understand why it doesn’t seem to be for most physicians.

But, knowing me. I have a few theories though and I would like to share them with you. Mind you these are just theories and I have no scientific documented proof, but I have had a hell of a lot of experience as a physician and as a patient and this is what I have seen.

I am worried that the physicians that seem so threatened by a patient that asks questions perhaps are just not confident enough in the care or the information that they are providing, or not providing as the case may be.

Well, this should never be the case. Be prepared at all times for questions and clarification. Know your patient so well that you can pre-anticipate what questions might be asked even before they are asked. Actually look at that chart before you enter the room. Anything you are unsure about? Look it up ahead of time and either be ready to talk about it or honestly admit that you don’t know,but are willing to help find someone who does.

It really is that easy sometimes. I get it. Not all conversations are easy. I am just saying that you have to put the pre work in to make things go as well as possible. Sometimes you are giving potentially horrendous news. There is nothing easy about that. It is not the patient’s job to reassure you, it is your job to reassure and support them. This news may make your day a lot tougher emotionally, but it may be changing their entire life all at once. It’s about the patient and your purpose is to help the patient so you gotta just pick up your bootstraps and do it or find another profession.

The bottom line is, I am not one of those threatened by patients being involved or asking questions. I welcome it with full on joy! Bring on them questions!

Dr. Katz

Am I seriously chastizing myself right now for not being busy enough?

Covid has really forced me to “slow down” lately. It really doesn’t give you any choice. Until you progress pass the point of feeling out of breath just by moving, you really don’t have any other option but to slow down. I am just not used to it. I am used to being busy. I thrive on being a multitasker. I feel like my mind is always on the next thing. But, now that I have some time to ponder it, is that really healthy or ok? Why do I like being busy so much?

Even before the covid slow down, I really started to notice that I was not as busy when I would look at all the social posts from dance mom friends. The constant competitions, rehearsals, and travel used to fill my life too. It has been a hot 3 years since those items have been on my agenda that’s for sure. But, I did put in 10+ years so I guess I paid my dues. I guess I have to say that I don’t necessarily miss the 4 am mornings and trying to figure out all the schedules, but there is a part of me that misses it all the same. I seem to have filled up the gaps nicely with work, writing books, blogging, doing the household finances, running an office, etc.

So again, back to the original question, why do I crave being busy? There are many reasons. I think that one of the most important ones for me is that when I am busy, I feel like I am contributing. I feel useful. I feel like I am “pulling my weight.” I know that is something I need.

Some people say that being busy is like a coping/avoidance mechanism. It is a way to stay focused and push away the worries about something that is bothering you and keeping moving forward. This is both good and bad. It is good in that you are not allowing something that is worrying you to stop you. But, it is not so good if you rely on keeping busy to avoid dealing with anything. Keeping busy is all good until it overtakes you to the point that you forget how to enjoy life or take anything in.

Jamie Bloch, psychologist and clinical director of MindMovers Psychology says that some people are actually addicted to being busy. When these people complete tasks, their brains actually release dopamine, which makes them feel good. I am not sure that I am actually addicted to being busy, but it does make me feel good.

Sometimes people feel the need to be busy because they are seeking approval. The need to please everyone keeps them from saying no to any tasks and therefore they are always up to their ears in activity. In the end, all this does is run them ragged and they probably do not get much in return for their efforts.

I think society expects us to be busy and in motion all the time. It all goes back to the sense of worthiness that I mentioned in the beginning. We all feel like we are worth more if we are accomplishing something.

The desire to be busy sometimes sets us up for failure. We tend to set up these gigantic to do lists that are sometimes impossible to achieve, which leads to anxiety and a sense of letdown. This is not healthy.

I think the key is to strike a balance between our productive lives and our restorative lives. Yes, keep our productive lives to accomplish and achieve and feel worth. But, also keep our restorative lives in which we practice self-care (which isn’t selfish) and take a minute to breathe, reflect, and preserve and let go of the notion that we need to be in motion every minute. I think that the key to doing this is to let go of the nagging worry about what society expects of us in terms of activity level and get to know ourselves more and what we can handle. I think we will all be a little bit healthier in body and mind for it.

Dr. Katz

It’s Easter

To me, first and foremost, Easter is about the resurrection of Jesus. I get it. But, also for me, there is a lot of other things to celebrate on this day too. There has been so much rebirth everywhere. From the minute details of the daffodils blooming to the emergence of myself and my husband from illness to the rejuvenation of old relationships: there is a sense of fresh start everywhere.

Second chances are everywhere, if we take advantage of them. I think this applies not only to religion, but to life in general. I have to admit, there has been so much change to take in that sometimes it’s overwhelming as well as wonderful. I am sometimes not sure how to process it all. I make sure to never let it overwhelm my sense of gratitude, but I am noticing that there is still an underlying sense of anxiety and “waiting for the other shoe to drop” again in my every day life. It seems to be affecting my whole family as well. I think it’s just normal with everything we have been through lately.

I realize that I need to make a conscious effort to keep moving forward, and to help my family move forward with me. We need to make the absolute most of and learn from these second chances. We need to focus on what gives us joy, even if it is something as small as watching my grandchildren hunt for Easter eggs or as monumental as hearing that my latest scans are clear.

So, as you gather with family and friends today to celebrate our Lord, also take time to celebrate each other and life in general. Take nothing for granted. Embrace every opportunity. Learn from each other and your own mistakes. Savor every moment.

Have a happy and blessed Easter.

Dr. Katz

Hiya PTSD! How you doin?

Truer words have never been spoken. I love this quote because it acknowledges the things you potentially can’t change, while redirecting you toward the things that you can.

Let’s talk about trauma. What the heck is trauma anyway? Trauma is defined as an emotional response to a terrible event. Immediately after the event, shock and denial are the most typical responses. Longer term response are more unpredictable and include mood lability, flashbacks, strained relationships and even physical symptoms like gi distress, headache, nausea and aches and pains. This sounds pretty straightforward but is actually much more subjective than you might think.

What is a terrible event? I am sure that we all have some standard ideas like natural disasters, rape, or war, but I am willing to bet that there are hundreds more, depending on the individual and the situation. It is not as black and white as it seems. Something that was pretty terrible for you may see like no big deal for someone else. To a large extent, it is a matter of perception. It is no one’s right to judge another on their response to trauma because it is impossible to truly be “in their shoes.”

So, what is post traumatic stress disorder? This is a mental health condition that is triggered by a terrifying event that is either experienced or witnessed. Symptoms include everything from nightmares, severe anxiety, flashbacks and uncontrollable ruminating thoughts about the event. It is normal to have temporary responses to trauma, but in individuals with ptsd, these responses don’t improve, often last for months or years and even disrupt daily functioning.

Well, I might as well tell you that I am having some ptsd after finishing chemo. Cancer, despite my positive attitude, still had it’s way with me mentally somewhat. It was, in fact, traumatic on multiple levels. Just like I have discussed before, I knew this was one of the risks after completing cancer treatment, not because anyone told me, but because it seemed logical. I mean, look at what my mind and my body have gone through. Chemo and the cancer itself blessed me with aches, pains, nausea, fevers, severe fatigue, neuropathy, etc and then when it was all over, my liver and kidneys took a hit and took awhile to recover….and then my thyroid died and it almost sent me into a coma….all when I was supposed to be done with all that! Mind you, I went through all of that while being off prozac so there was no mental health/anti anxiety buffer available so it was full on unrestrained feels and fear all day long. I got through it. I mean I am getting through it, but it has left some scars. Every twinge or pinch sends my brain racing with death defying possibilities if I allow it. Because, twinges or pinches meant something was terribly wrong before right? So why wouldn’t it mean that now? Oh yes, that’s right. I just had scans that were clear not even a month ago. I am ok. I saw it on film myself. Still, those rational thoughts aren’t the first ones that come to my mind when those symptoms come up.

Last night I was having a basic fibromyalgia flare, brought on by stress, like I have had a million times before, even before cancer. This time, you would have thought that I was dying. I started panicking. I decided that I wasn’t going to the party I was planning on attending. I put myself to bed and started ruminating on all the terrible possibilities until my amazing daughter pointed out that the symptoms were the same as always and she gently reminded me about the stressful day we had. Listening to her broke though my fear bubble just enough that I was able to get myself together and actually go to the party with my husband. We had a great time by the way. Thank goodness for her understanding and her voice of reason when I was being somewhat irrational. But, that’s what post traumatic stress is. It’s irrational. You sometimes cannot see your way out of it without some help.

As the quote above states, the kind of trauma that causes ptsd causes change that you don’t choose. I didn’t chose to get cancer and have organs shut down and be sick for months and months. That was a trauma and that is still affecting me. But, I can choose to continue to heal and get help for my symptoms rather than settling into them and just accepting them as if this is how the rest of my life is going to go regardless of my say so. I do have a choice! I am getting therapy. I am learning ( or trying to learn) new coping mechanisms. I am listening to my family. I am realizing that I do not have to turn in my Wonder Woman status just because I am dealing with this. I am embracing the fact that this is a battle that I do not have to fight all by myself and that is ok.

Speaking of not battling alone, I wanted to leave you with a screening guideline for PTSD from HelpGuide

Do you think you could have PTSD? Here are some screening questions. If you answer yes to three or more of these, you may also have PTSD and should seek help and therapy from a qualified mental health professional.

  1. Have you witnessed or experienced a traumatic, life-threatening event?
  2. Did this experience make you feel intensely afraid, horrified or helpless?
  3. Do you have trouble getting the event out of your mind?
  4. Do you startle more easily and feel more irritable or angry than you did before the event?
  5. Do you go out of your way to avoid activities, people, or thoughts that remind you of the event?
  6. Do you have more trouble falling asleep or concentrating than you did before the event?
  7. Have your symptoms lasted for more than a month?
  8. Is your distress making it hard for you to work or function normally?

If you answered yes to three or more of these questions, you can get help. Cognitive Behavioral Therapy can be very helpful. When you look for a therapist, make sure to look for someone that specializes in trauma and PTSD. There are also a multitude of PTSD support groups in Michigan, which is where I live. Here is some contact information.

  1. PTSD Support Group- meets in Allen Park, Mi. Hosted by Juanita Hinton 734-530-4371
  2. Trauma Recovery Empowerment Group- meets in Warren, Mi. Hosted my Tracy Denice McCall 313-635-0188
  3. Women, Trauma, and Addiction- meets in Novi, Mi. Hosted by Dr. Trisha Stock 248-721-4534
  4. ACT for Anxiety and Trauma-meets in Ann Arbor, Mi Hosted by Dr. Amy Paggeot 734-345-1356

These are just a few resources. My point is, if you think you are suffering from PTSD, don’t go through it alone. There is help out there. You may not have chosen the trauma that was inflicted on you, but you can chose not to be it’s perpetual prisoner.

Dr. Katz

I just don’t know how to feel.

So, as I understand it, the end is near for my cancer treatments. This week is supposed to be the week. The last chemo. Wow. Just to say it out loud is really something. It doesn’t even seem real. Could it really be true? Of course, when I speak in terms of the end, it is not really the end. The next five years of my life are pretty well mapped out with follow ups and scans and appointments. It is really at the end of those five years that it is really “over,” not just at the end of chemo. There will always be that little forever shadow monkey on my back that things could take a turn for the ridiculous again.

I would be lying if I said that I am not excited about the prospect of chemo being over. But, weirdly, at the same time, I am a bit terrified as well. No more chemo?! While that means, hopefully, no more of the awful side effects after they all wear off. It also means no more internal liquid defense system. It also means that there could be more opportunities for the cancer to creep back into my life. Hmm. How will I know if it is coming back? In the interest of respecting the post traumatic stress aspect of being a survivor, I made a promise to myself not to panic at every little twinge or symptom that I experience after treatment is over, but should I? Or should I be hypervigilant? I don’t really know the right answer.

I am looking forward to feeling like myself again, to having stamina, to being able to exercise, to being able to have hair again (hopefully completely different and thick and amazing), and to feel, dare it say it, sexy again. But, I hear that that is going to be an additional wait as well. I have been told that it can take up to six months before patients feel back to baseline. This kind of statistic just makes me anxious because I suspect that it will be a natural tendency for everyone, including myself, to expect me to pick up right where I left off before treatment as far as work and life in general. I have a gift for putting extra pressure on myself and I am sure this will be no different. Well, at least I am consistent in that regard…lol

Basically what I am saying is that I am kind of all over the place right now. I have no idea how to feel. Part of me is ready to throw caution to the wind and literally have a party( socially distant of course) to celebrate the end of this chapter. The other part of me realizes that there is a whole lot of other stuff to consider before the party can begin.

Dr. Katz

What is it about the last weekend of vacation?

What is it about the bittersweet last weekend of vacation? I find that it seems to drive most of us crazy. Instead of soaking it up and metaphorically holding on with both hands, we begin to think forward about all the things we put on the back burner, fretting about what’s ahead. Insidiously conversations get more tense and work creeps back in before the deadline. That last bit of precious time becomes wasted. The cellphones turn back on, the computers get fired up? Why? How can we avoid it? This phenomenon is so common that even the Today Show has done segments on the end-of-vacation-blues and the Sunday Scaries.

So again I ask, how can we avoid the blues? There are some tips out there. For example, travel psychologist Scott Haas says that we need to step back and consider ourselves lucky that we got to take a vacation in the first place. Did you know that half of Americams don’t even use all their vacation days, if they even get some in the first place?

In the Personal and Social Psychology Bulletin, University of Chicago psychology fellow Amit Kumar and Cornell professor Thomas Gilovich recommend that you focus on experiential purchases rather than souvenirs while on vacation. By purchase they don’t necessarily mean spend physical money but rather the investment of time in doing something unique that gives you something with interesting details to share. You will probably have a lot more to talk about after a hiking trip in the mountains as opposed to a pendant or t shirt that you bought.

Another tip is to start planning your next trip. That doesn’t mean discount everything that you just did on vacation. It just means start making a straight forward list for your next trip to help it become a reality and something else to look forward to. There is something called the Zeigarnik Effect that refers to our tendency to remember incomplete tasks more clearly than ones we have finished. Translate that to trip planning and if you have thoroughly planned your next trip it may free your mind from the intrusive “what’s left undone” thoughts that can plague you toward the end of vacation and actually help allow you to enjoy the last few days. That can even apply to tackling your untouched email inbox without guilt while you are on the flight home so you can relax when you get there before work the next day.

USA Today suggests that you nurse that post vacation culture shock. Instead of asking yourself why am I in boring old (insert hometown here) instead of exciting ( insert exotic vacation local here), remind yourself why you moved to your hometown in the first place. Remember why you love it. Reminisce over good memories.

There are a few things you just have to get off your butt and do when you get home: unpack your bags, do your laundry and grocery shop for heaven’s sake. Those suitcases and mountains of dirty laundry will only serve as monkeys on your back and feed your longing to be somewhere else. Grocery shop for healthy food to detox your body from vacation food. It will thank you for it and leave you with more energy to face your new old schedule.

Currently I find myself facing the end of a vacation. I am following my own advice by writing of this blog as an example of finishing a to do list to free my mind to enjoy my last bit of time. I am also reminding myself how much I love my family, my animals and my memories. So far, it’s working. I hope these tips help you too. Have a fantastic day.

Dr. Katz