Cancer and lingering anxiety

Cancer and lingering anxiety

My mail was delivered at 9 p.m. last night. An odd occurrence. Maybe the mailman is avoiding the heat. I picked up the neat bundle and hoped for real mail. All I found was advertising and a letter from a doctor’s office, which contained a referral for my next cystoscopy.

The quarterly cycle of anxiety begins again. I was diagnosed with bladder cancer last summer and completed treatment in November. Now, I’m on a three-month cycle of scopes to check for signs of recurrence.

I know I’m lucky. My tumor was stage one and low grade; surgery and follow-up treatments were successful. The scopes have so far shown no evidence of disease. Some people in my situation consider themselves “cured” or “cancer free.” I can’t bring myself to use those words, and I cringe when others do. It feels like tempting fate.

Cancer doesn’t really have a beginning and an end. The truth is that we have no test that can certify a person as cancer free. Once diagnosed and treated, even successfully, there are residuals, one of which is anxiety.

Oncologists are even studying the phenomenon of lingering anxiety. Jan Hoffman, writer for the New York Times, reports the seriousness of anxiety.

Now a new analysis finds that within two years of a cancer diagnosis, the pervasiveness of depression in patients and their spouses tends to drop back to roughly the same levels as in the general population, only to be replaced by another mind-demon: anxiety, which can even intensify as time passes.

Just like me, other cancer patients feel the anxiety build around test time. About one cancer patient, long past treatment, Hoffman writes:

Her body works like an unconscious calendar. In early June, she becomes edgy and nervous and begins staying awake till 2 a.m., reading. Then she and her husband check their real calendars and, sure enough, her annual checkup is just a few weeks away.

Anxiety is no stranger in my life. I’ve always been in its grasp, and it dampens the joy of many experiences. Anxiety has been the greatest challenge of my adult life.

One of the trickiest parts of coping with anxiety is that we all know that life does go wrong, often enough and terribly enough that worrying about it isn’t unjustified.

Daniel Smith writes:

The second glitch is more complex and has to do with the nature of anxiety itself, which for all its attendant discomforts and daily horrors has at its heart a vital truth, even a transcendent wisdom. This truth — which, confusingly enough, doubles as the source of anxiety’s pain — is of the essential uncertainty and perilousness of human life. Its fragility and evanescence. Anxiety emphasizes these aspects of existence with an almost evangelical fervor. It hisses them, hour by hour, minute by minute, into the sufferer’s ear. “Anything can happen at any time,” anxiety says. “There is no sure thing. Everything you hold dear is at risk, everything is vulnerable. It can all slip through your fingers.”

For a person who lives in her head, like me, the rational isn’t much of a cushion. Reality tells me that I’m vulnerable, like anyone else is vulnerable. Bladder cancer has the highest rate of recurrence of any cancer, from 50 to 80 percent. Statistically, I’m more likely to have a recurrence than I am to avoid one.

The scopes keep a close watch on the bladder. A tumor, if it’s ever there, will likely be small and in an early stage. A cystoscopy is a good thing. My brain knows this, but my nerve endings don’t. It’s like a prison break. The spotlights snap on with a buzz and the alarm whines.

I’m making some progress on dealing with anxiety. I’m accepting the irritation of the paper work and the tests that precede the quarterly cystoscopes. I’m learning to feel grateful that I’ve got a good medical team. I practice relaxation and faithfully attend my support group.

Still, if I let my mind wander I think about how I’ll respond if my doc sees something after he threads a cystoscope into my bladder. Will I cry? Will it be worse than the first diagnosis? Will the doc be worried? How will I tell my husband? How will I tell my daughter?

There’s an odd part of me that embraces the process once it begins. I love checking off each step. Appointment scheduled, check. Urinalysis, check. Referral, check.

The night before the exam, I spend an absurd amount of time choosing clothes to wear the next day. The next morning I’ll blow dry my hair and put on makeup, even though it’s summer. Part of getting through the process is getting into character. I want to look like a smart, professional, together person.

Not that the doctor or his staff would ever notice. All he sees is the blue crackly paper cover from waist to knees and, of course, the bladder. He may say something “personal” to me, but he knows less about me than the baristas at Starbucks.

If the test is clear, he’ll ask if I have questions as he thinks ahead to who’s next. If I have questions, he’s more than willing to answer them and to take time, but I feel it’s indulgent to take any of his time.

Instead, I say very little, he leaves and I feel oddly deflated. An all-clear, what with all the build-up and anxiety, feels anti-climactic. I feel strangely more vulnerable than I did when I walked in.

When anxiety comes, it ratchets up inside, getting tighter and tighter. I wish that it would come unsprung as soon as the doctor’s visit is over. Winding up feels natural, but winding down takes concentration and work.

Breathe in through the nose, out through the mouth. Shake it off. Shake it out.

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