If You Recall the Past in Detail, You'll be Less Depressed than if You Recall it Only Generally

Australian firefighters who experienced trauma were more likely to have PTSD if they couldn't recall the events specifically.
That is what the New York Times is telling us.

The Times reports: “People with P.T.S.D. tend to ruminate at a very categorical, general level about how unsafe life is, or how weak I am, or how guilty I am,” said the lead author [of the firefighter study], Richard Bryant. “If I do that habitually and then I walk into a trauma, probably I’m going to be resorting to that way of thinking and it’s going to set me up for developing P.T.S.D.”

Overgeneral memory can protect people from traumatic memories and such people have it easier than those who think back to the trauma specifically--in the short term.

Without detailed memories to draw upon, dispelling a black mood can seem impossible. Patients may remember once having felt happy, but cannot recall specific things that contributed to their happiness, like visiting friends or a favorite restaurant, according to the Times.

“If you’re unhappy and you want to be happy, it’s helpful to have memories that you can navigate through to come up with specific solutions,” Dr. Williams said. “It’s like a safety net.”

Mindfulness meditation can help people accept their negative memories and not ignore them, according to Dr. Williams. “I always tried to forget the past, the very bad past that made me depressed when my husband died,” said Carol Cattley, 76, who attended a mindfulness course here [Oxford, England] taught by Dr. Williams. “I’m much more interested in it now.”

[Image: Meditation by Alphonse Mucha]

Day 5 post-treatment

On Tuesday I had the Neulasta shot to boost my white blood cell count. On Wednesday evening I developed some back pain that may or may not be related to the joint pain side effect I was told I might experience. So I called the onc, and took Vicodin, and took Vicodin, and took Vicodin. Even on Thursday evening my neck was stiff and uncomfortable. Today it seems better.

I felt the beginnings of nausea last night and this morning as well. They tell you to take the anti-nausea meds at the first sign of an upset tummy so that it can act before you feel really ill, which I did promptly as soon as I realized that what I was experiencing was nausea.

Yesterday I met with a new shrink at the Cancer Institute (my former psychiatrist is no longer in practice). Thankfully Pacificare Behavioral Health allowed an exception for me to see Dr. Dobie, and now I believe she is on their list of preferred providers. She asked me five pages of questions from her "get to know you" assessment. We agreed that she would be a good fit for me, and that I need one more tool in my cancer toolbox.

I wanted to see a shrink because no matter how wonderful a support group can be, you still have to share the focus with the other people in the group. In our 45 minute sessions, Dr. Dobie is there only for me. I don't have to worry about hogging the limelight or talking too much.

She recommended increasing the Zoloft by another 25 mg in order to improve my sleep (insomnia is a problem with depression) and told me that I could take Ativan to get better sleep any time.

Last night, between the Vicodin, the anti-nausea drug and the Ativan, I got the best night's sleep I've had in days. That's certainly a step in the right direction.

The morning after

Either my anti-depressants have really kicked in, or I am still getting benefit from yesterday's steroids, because I slept well all night (except for three hot flashes that were borderline night sweats at 2 AM, 5 AM and 7 AM).

I have no nausea this morning; took my second of three Emend tablets and they seem to be doing the job. I even asked Dr G to give his hopefully positive opinion on taking our planned beach vacation, if I continue to feel well.

I feel back to my normal routine today. Walked the dog (sigh... only one dog), hope to be able to see the orthopedist, meet with an estate planning attorney, and attend an afternoon meeting. That would be a lot for me on a regular day, much less the day after chemo.

Even my left arm feels more extended after NOT sleeping in the black plastic orthopedic gizmo. We'll see what the orthopod says about that. Remember, I'm not bandaging for three nights to prevent hand-foot syndrome from starting.

Say it with me. Doxil will be::

Very effective
Manageable side effects
Well-tolerated

First Doxil

Today I received my first treatment of Doxil (doxorubicin). First they gave me a new anti-nausea drug called Emend (given by IV), then i took Decadron (a steroid) and Ativan (for anxiety) orally. Then they finally set up the Doxil. Two chemo nurses sat with me to monitor how well I reacted and to make sure there were no problems. They gave it very slowly at first, then began increasing the speed. It took about 90 minutes - two hours for the whole infusion.

Doxil is a bright peach color, or as one nurse put it, exactly the shade of peach Jello. I don't eat too much Jello but I liked her softer imagery.

I felt quite chatty, especially compared with my morose behavior of the past few days. Either the Zoloft (anti-depressant( is kicking in quickly, or the steroids gave me just enough lift. D and C came to visit and I was able to have good interactive conversations with them both. D called me "perky." Either way, I rose to the occasion and provided the nurses with information they needed.

One bit was about the interaction of lymphedema with hand-foot syndrome. Evidently, if you get this, it comes on for a few days immediately after treatment and then eases. You can help prevent it by taking tepid showers; not using knives or tools; not kneeling or leaning on your arms. So far none of the providers recalls treating anyone with hand-foot syndrome who also has lymphedema. I have left a message with my physical therapist asking about her experience and I'm sure she will call back if she has a solution to offer.

Meanwhile we have decided that for these first three or so days post-Doxil, I will cease all lymphedema management to avoid putting undue pressure on my palms, and then return to night-time bandaging more loosely (if I can do this). At least I have a plan.

We came home with two prescriptions: Emend is given via IV on treatment day, and then via oral pill on each of the next two days. I have oral Zofran to manage additional nausea, should I experience any. And despite his not wanting to order me additional Ativan last week, Dr G wrote a new scrip for Ativan today, so I am covered for both anxiety and nausea.

It all went very smoothly. I was surprised that my counts were high enough to permit starting this treatment, but Dr G thinks it's best to start asap and he's the boss of my cancer. And last Thursday he said in plain words, "Your cancer is going to get better."

Help for depression

Today I was diagnosed with moderately severe depression and I start sertraline (Zoloft), an anti-depressant tomorrow morning. I also had an echocardiogram to discover if my heart is healthy enough to tolerate the Doxil.

I realized how fortunate I have been to have bone-only disease for the past seven and a half years which responded well to aromatase inhibitors and other anti-estrogenic, oral meds. How quickly I forgot that I felt well most of that time. (Aside from the pain of a broken leg, new bone mets, back pain...)

Chemo freaks me out and yet I read every day that so many of my mets-sisters manage to live well on it long term. Still, having Abraxane fail after only two months scares me.

This evening I suddenly realized that I have dealt with cancer for 20% of my life -- 11 years. I barely remember the other 80%: it flew by when I wasn't paying attention. Or maybe that's the depression talking.

Depression update

Although I am still as deeply depressed, I have taken some steps in both directions (including some back into bed).

I contacted my former shrink, who called me immediately and offered to speak with Dr G about anti-depressants. I guess I will hear the results when I see him today and find out about yesterday's scan.

The CT scan required me to drink a bottle of barium solution, then get my port accessed, then drink another bottle of barium solution. Sometime in the midst of being accessed, I vomited up a portion of the barium. The taste was awful, my stress level is sky-high, I had a hot flash and the nurse couldn't quite get the needle in the right place in the port. POOF -- vomit. The nurse then walked me back to the radiology department and confirmed for them that I had indeed vomited and should not drink the second bottle of barium.

From there the scan went smoothly and was over quickly. I asked for a place to lie down for a few minutes and was given a pillow and blanket to soothe me. I practiced my yoga breathing for a while and then was able to meet a friend for lunch.

Lunch was just the opposite of what Dr G has requested in terms of low carb diet. I wanted something gentle on my upset tummy and what could be more bland than noodles with alfredo sauce? I wasn't hungry but forced myself to eat anyway. L and I took a short walk in the sunshine and I went home to crash.

I tried to contact Pacificare Mental Health and get a referral to a psychiatrist who specializes in chronic illness, but was again thwarted. There is only one such doctor contracted in the entire city of Seattle. The one who didn't return my call from Monday. The Pacificare "care advocate" offered me an appointment with someone in Bellevue, but I explained that I have so many medical appointments already, I didn't have the time or energy to drive to Bellevue once a week.

As soon as possible, I wrapped my arm, put on the plastic orthopedic gizmo, took a milligram of Ativan, got undressed and into bed. I got up occasionally, once to take a call from my primary care doc. She insisted that I call her office today and get in to see one of her colleagues while she is on vacation. So on Friday I have rearranged my schedule to see yet another doctor who can hopefully assess my situation properly and begin prescribing me the right medication to treat this depression.

I also contacted my naturopath to get his take on this situation. A friend from my online support group mentioned that when you wear fabric (scarves, hats) over your bald head, you prevent any UV light from reaching your pineal gland. I must ask him about this.

So far it's not affecting me to eat only two meals a day. Skipping dinner three days in a row has not impacted my weight or made me particularly hungry in the morning. I will eat because I know I have to, not because I want food.

What's new

I was reminded today by a good friend that I haven't posted here in a few days. Things are generally okay but when piled together, I find I am in need of professional support.

1. Treatment with Abraxane continues to be very tolerable with minimal side effects. I have a CT scan tomorrow (and get the results on Thursday) which should indicate any response so far. Dr. G's plan is to treat me until he sees a response, then add two more months. I think that puts us at re-scanning in three months, getting the hoped-for response, and maybe ending treatment in November. You can see how so many months of chemo appears daunting to me.

2. Lymphedema continues to bug me in the same way -- too much edema in the hand, which is exacerbated by wearing the sleeve and glove. I've been taking a psychological break by not wearing anything during the day, and wrapping at night. This has gone on for about a week. I was measured for new custom sleeves last week. This new brand is supposed to be worn with a glove of the same brand; together they presumably put less compression on the wrist. A regular sleeve and glove, when worn together as appropriate, put MORE pressure on the wrist, thus giving the potential to increase edema in the hand by forcing more fluid there. More stress from this.

3. The left elbow continues to be stuck at about 40 degrees of extension. Even after wearing the black plastic brace every night for two weeks, over my lymphedema bandaging, I still have only 40 degrees of extension. My therapist worked with me to position the brace in a more effective spot on my arm, which may result in additional extension. Or not. I see the orthopedist next week. I do not sleep well at night while I wear this gizmo and yet it seems to be the only thing that will return full extension to my elbow joint. Again, more stress.

4. Pumpkin's death continues to hit both of us hard. He pops into mind at odd moments. It's hard to close my eyes and not visualize him looking back over his shoulder to see where I am. Having Bobka helps a lot but still...

5. Eating the low carb/low sugar diet that Dr. G recommended is very fatiguing. I am tired of having to think about every bite, having to plan my carbs each day. Yesterday after my low carb breakfast of cottage cheese, fruit and a latte, I was hungry again at 10 AM. A coffee and half a piroshky helped, as did the (rather dry) tuna sandwich later supplied by the Cancer Institute. I didn't eat dinner last night (read on). Today I ate bread at breakfast, which pretty much consumes my carbs for the rest of the day. But at least I felt full.

I feel so overwhelmed by all that I am managing that last week I decided to seek professional help. I had lined up an appointment with one of the two psychiatrists associated with Swedish's Cancer Institute only to discover that neither of them is part of my mental health benefit network. I found this out yesterday, after spending six hours at the Cancer Institute, and was given one name, in all of Seattle, of a psychiatrist who specializes in treating people with chronic illnesses. He has yet to return my phone message from yesterday. I feel I am in serious need of anti-depressants but would prefer this kind of drug to be managed by a mental health professional rather than my oncologist or even my primary care doc, who is not in this week anyway.

When things are too much for me, my preferred method of coping is to go to sleep. I got into bed at 3 PM, with instructions to Rik to wake me if the one shrink called. I did get up a couple of times, but basically I self-medicated and spent 18 hours in bed. I woke up this morning, not exactly refreshed, but feeling more ready to take on a new day. That lasted until now, when I started writing this post.

Long story short, if you don't see a new post from me, it doesn't necessarily mean all is bad. In the past week I also chaired my first meeting of the synagogue board as president; went shopping for makeup with a friend; and laughed through an animated movie. In coming weeks we may go out of town. I appreciate that you all care and I promise will keep up on my blogging as much as my energy permits.

More on Happiness: Can 79 College Students be Wrong?

The New York Times blog tells us that happiness comes from deep discussion, and not from shallow. That's based on the experiences of 79 human guinea pigs at the University of Arizona, and I see the conclusion as an argument for getting a degree in creative writing. The late Carol Bly wrote about creative writing classes as oases of meaning in "American junk culture." So how about a slogan for AWP:
Study writing, get happy.

Farewell, tortured poet. Leave your troubles inside your garret. Come to the cabaret.

You can read about the Suicidal Poet Predictor in Scary Place to see the difference in vocabulary and subject between suicidal and non-suicidal poets. According to Scary Place,The poets who committed suicide used many more first-person singular self-references such as "I," "me" and "my" and fewer first-person plural words than did the non-suicidal poets [according to a study by psychologist James Pennebaker and graduate student Shannon Stirman in Psychosomatic Medicine].

"Issues of identity, isolation and connection to others is revealed in pronoun usage," Pennebaker said in an interview. "One of the most telling words of all is the word 'I.' People who are suicidal or depressed use 'I' at much, much higher rates, and there's also a corresponding drop in references to other people."

The suicidal poets also generally reduced their use of communication words such as "talk," "share" and "listen" over time heading toward their self-inflicted deaths, while the non-suicidal poets tended to increase their use of such words. The suicidal ones also used more words associated with death, but surprisingly the amount of words with negative emotion (for example, "hate") or positive emotion ("love") did not vary significantly between the groups.

Those of you who read this blog know that suffering is included with the price of admission. I remember once when I came home from college I was talking to my aunt B and we had both read The Bell Jar. I told her that Sylvia Plath (pictured above) had described the way I felt. She was surprised. Alarmed. And that was the end of it. I think Plath had already killed herself by then. I have not. She died before the really good drugs were invented. And the good drugs aren't good for everybody.


I met a woman today who lectures and writes about humor in the Bible. The funniest story? The Book of Job, she said. Seriously.

Suffering

If anybody ever offers you the choice between suffering and depression, take the suffering. And I don't mean physical suffering. I mean emotional suffering. I am hereby endorsing psychic suffering over depression.

Don't get me wrong; suffering, though universal, and though its universality provides the basis of Buddhism, is bad. Today I suffered. It meant being weepy, rageful at the drop of a pin, filled with ire at someone for being 14 minutes late (when it didn't matter at all; and I didn't show my rage) and at a fucking stupid fucking imbecile waiter who didn't know that a goddam fucking matte is supposed to be dark and smoky, and not the color and taste of pale green swill with little green specks in it. (I didn't yell. I had a sharpness to my voice a few notches below sarcasm and I smiled deceitfully. I gave a good tip.) At the coffee house and after I was weepy from time to time and not able to balance in Warrior One pose in yoga because my toes were numb from the horrible Taxol. I wept into my purple yoga mat while folded into child's pose and then wept face up into the open air with closed eyes and sweaty head (my perpetual clammy head, compliments of Taxol and menopause) while lying on my back with my legs in butterfly and then I accepted defeat, that the weeping would not end, and rolled up said mat and walked up the street to the drugstore to pick up some refills and a drug that Nurse L had just called in to combat the numbness. Suffering meant crying out when a person crossing the street with an umbrella over her head nearly ran me down, and suffering was going to the drug store and finding out that the very new dolt of a clerk didn't have my new drug, it would take ten minutes, he said. I was weeping and hovering at the counter like a desperate addict in my rain-dropped-on bald head, t-shirt and torn shorts, and I went back to him and said, Could you give me just a pill or two for now, and finally, Could you make a little faster because I'm in a lot of pain, and feeling a little guilty because I wasn't in pain-pain, not about-to-die-and-double-over pain, but in weepiness pain, the pain of not wanting to be there, standing around and weeping and feeling a hole in my heart of desperation and sadness and rage. A dark wound in my heart. And suffering meant walking home with my three drugs finally, my umbrella above my head, knowing I would be home soon, where I would be able to collapse and even work on the stupid idiotic fucking book review, because I was suffering and not depressed. Suffering meant I knew that crying would make me feel better, once I could stop, and that I knew that underneath the suffering I had a core of appreciation for the thunderstorm that had broken the hot spell this afternoon, even though it had drenched my poor bike and helmet that I'd left moored to a parking meter on the street. Underneath the suffering was psychic pain, which is an entity, but I can deal with an entity, it is better than the erosion created by depression, which is more absent than absence, depression is the oxygen-gulping aridness of the void, and it fills every part of you with the knowledge that nothing matters, the universe is as meaningless as it is infinite. So that there is no part of you left that can slither its way around and get its interest quickened by an idea or person or mind or glazed blue Moroccan tile. There is no room for beauty or Marx or charity or alternatives to war. There is only the ash that's left after a fire, after a long long rain.