Travel Again

London's Big Ben and Houses of Parliament

In an earlier post I talked about the psychological and physical benefits of travel. Whether it’s a short excursion or a major trip, I find travel to be a way of changing my perspective regarding myself and my illness as well as of the world around me.

Last year when I was diagnosed with a return of my kidney cancer some seventeen years after the original episode, one of the first questions I asked my oncologist was: Will I be able to travel? His answer was that if the treatment was stable, then yes. In May I took him at his word in a way more vigorous that I’d previously ventured. A few short excursions and a February week at a San Juan resort had proved successful, and so in May we spent most of the month traveling abroad.

The first leg was leisurely: a thirteen-day transatlantic cruise to England. The first seven days of the cruise were simply at sea, which was very relaxing. Thereafter we began stopping at various ports. In the Azores and Lisbon, Portugal, we got off the ship and wandered around the port towns. In Spain and France, we took bus tours to sights we wanted to see. Once we landed in Southampton, England, however, our travel became more energetic. Over the next ten days, we spent several days in London, sightseeing and enjoying West End theater most evenings, then we took the Eurostar train to Paris for a few days of sightseeing. After that, we returned to London for a few more days before flying home.

The combination of cancer, treatment, and side effects tends to limit my energy; and so there were some concessions, such as a daily nap. We would have breakfast, do a museum visit or some other activity, have lunch, and return to our hotel so that I could have a nap. Then we’d be able to enjoy late afternoon, dinner, and evening activities. We did quite a bit of walking, and I occasionally used my walking stick to take some pressure off my perpetually sore, swollen feet (a side effect of the cancer treatment). Often we zipped around London or Paris on the subways, which invariably got us close to our destinations.

A couple of other concessions: We left our largest suitcase in a railway left-luggage facility in London rather than schlep it to Paris. And I reserved a chauffeured car to Heathrow airport on our last day, rather than deal with luggage on the airport train.

London and Paris have been favorite destinations over many years, and being able to visit them again was psychologically energizing even though it was physically exhausting. My attitude has been that cancer is unpredictable, and who knows if I’ll get another chance to travel in this manner. The maxim, “Seize the day,” seems all the more reasonable, given the circumstances.

And the trip was exhausting. As I write this nearly a month after our return, I’m still struggling to regain some energy. Prior to the trip my oncologist noted that my anemia was worsening. Upon our return, he switched me from the daily iron tablet, which didn’t seem to be effective, to iron infusions. I’ve had two infusions now, a week apart, and hope they’ll eventually help decrease the anemia and return some energy. Anemia is energy-zapping. In addition to fatigue, it makes my fingernails like tissue paper, shortens my breath (because fewer red blood cells are available to carry oxygen), and diminishes my appetite. I often feel too tired to eat. I lost about ten pounds, mostly during the last two weeks of the trip, and have lost a few more here at home. While I can stand to lose a bit of weight, I’m trying to slow that down. I don’t recommend anemia as a weight-loss program.

But, bottom line, would I do it again? Absolutely! I have a passion for traveling. Other people have other passions. I tend to believe that in pursuing one’s passions the benefits outweigh the negative consequences.

Exercise

Confession time: I have never been an avid exerciser. That said, I have always loved walking, particularly alone in the woods—not with any goal of speed or rigor but, rather, contemplatively. Ambling along I am mindful of wildflowers, small creatures, wind in the leaves, the tapping of branch on branch, woodland aromas, geese honking on a distant pond, small birds nearby calling to one another. However, these impressions are fleeting, as my mind invariably is churning and turning—ideas, plans, memories, imaginary conversations. Sometimes I look up and wonder where I am. Deep in thought scarcely covers it. I’m sure my walks don’t constitute much actual exercise, but I believe they are healthful.

Meditative mindfulness—call it walking meditation perhaps—takes me both outside myself and deeply within, contradictory as that sounds. I find such mindfulness in the woods. I also find it, albeit slightly less easily, meandering down city streets, admiring architecture and interesting shops, and of course people-watching. Or in gardens, modest or magnificent. And in art museums and galleries, especially there. Anywhere, really.

One side effect of Afinitor, which I am currently taking as a treatment for renal cancer, is swelling and soreness in the extremities. It can affect other areas, such as hands and face, but I feel it in my feet and ankles, particularly late in the day and more so if I have been standing or walking quite a bit. That condition is aggravated by a longstanding neuroma in my right foot. I have purchased and sometimes use a walking stick.

A bit of style, in my mind, goes a long way toward alleviating the feelings of age and infirmity that come with using a cane, even if such use is merely occasional. Mine is a Fritz style with a dark Ovangkol shaft (an African wood similar to rosewood) and an olivewood handle, joined by a gold and silver band. Using the walking stick helps take some pressure off my “bad” foot. I also have a folding cane to use when traveling. So, I’m still walking, a bit less and a little slower, but still putting one foot before the other.

Meanwhile, I’m also keeping up with yoga (see the earlier post) and walking the indoor track at the local YMCA some mornings. Now that spring has arrived, I’ve aired up my bicycle tires. A few years ago I stopped dodging traffic on city streets and now ride almost exclusively on a rail-to-trail path, which also has the benefit of being level. Still, it’s exercise—and quite enjoyable, all fresh air and sunshine. I might even suggest that it can be a form of rolling meditation.

Creating

Iguana, acrylic on canvas

Creating, whether one writes, paints, arranges flowers, or what have you, takes a person outside him- or herself. That’s always been my experience. I can be lost in a manuscript on the computer or in layers of paint on a canvas for hours, oblivious not only to the passage of time but also to pain and hunger.

Painting, for me at least, for as much as it takes me outside myself, it also takes me inside—to a different place, a deeper place, somewhere beyond the conscious. There is something primal about pushing paint around on canvas. Even when it is a frustrating exercise, which it often is, there is still something uniquely satisfying about it. Contradiction upon contradiction. It is both energizing and calming.

I scarcely recall a time when I did not paint, and I can’t imagine a time when I won’t want to. I’m certainly not alone in persevering despite various odds: finding the time, energy, and drive to ignore the side effects of my cancer therapy and just get on with it. Some famous examples are worth considering. Painter Georgia O’Keeffe in her final years continued to paint even as macular degeneration dimmed her eyesight. Classical pianist Arthur Rubinstein did not give up performing until he was virtually blind. Both continued creating into their nineties. Ludwig van Beethoven began experiencing hearing loss early on and was nearly totally deaf when he composed some of his best-known works.

Cat Chair, acrylic on canvas

Modern artist Henri Matisse was diagnosed with abdominal cancer at age seventy-two. When surgery left him bed- and chair-bound, he turned from painting to creating paper cut-outs, for which he became almost as well known as for his earlier paintings. He continued creating in this new way for the next decade until his death at age eighty-four. Impressionist painter Pierre-Auguste Renoir developed rheumatoid arthritis that left his hands paralyzed and so had his brushes strapped to his hands in order to continue painting until his death at seventy-eight.

If you are a creative person — a writer, a painter, a composer, a performer — you cannot not work, you cannot simply stop. You must create. Against all odds.

Note: Displayed are two recent paintings I composed as remembrances of a vacation trip to Puerto Rico a couple of months ago.

Travel

Travel is a passion of mine, at least to the extent permitted by time, money, and energy. Prolonged medical treatment, for whatever condition, necessitates adjusting one’s schedule to accommodate doctor visits, procedures, and recovery. Diminished energy can be ongoing. For me, consequently, treating kidney cancer has meant curbing some travel, though fortunately not all and not permanently. 

A peripatetic childhood as the son of a career Army serviceman permanently engendered in me a love of travel. Traveling, for all that it can be exhausting in the moment, is wonderfully energizing for the senses. I prize the mental stimulation that comes from encountering unfamiliar people and places. I am never more fully alive than when I take on the role of foreigner, navigating the unfamiliar with my wits stretched to ingenuity.

It doesn’t matter whether I’m actually in another country or merely away from familiar surroundings by only a few miles. There’s still an intriguing “foreignness” in being the stranger. Travel encourages independence and broadens my outlook. Over the years travel has given me many good memories, adventures to be recounted, incidents and characters to be woven into my own writings, and sights to inspire drawings and paintings.

The diagnosis last spring that my renal cancer, to which I lost my left kidney seventeen years ago, had returned forced my then fiancé and I to cancel a planned tour of Italy. Later, in the fall, I had to cancel another trip, this time to Kansas, because of some fairly severe side effects. With that period behind me, however, and with a new targeted therapy regimen in place and working well, I have now cautiously begun to travel again.

Initially I stuck with short, local excursions. There was a convention trip that required a few hotel nights in Indianapolis, only fifty miles from home. That November trip was followed by a pre-Christmas trip to St. Louis in December to visit my daughter. And there have been several day trips. All of these outings were done by car, which served as a kind of security blanket. Whether alone or traveling with my now spouse (we married in mid-August), driving has allowed me a measure of control. Driving on my own has helped to reestablish my sense of self-confidence.

Of course, like anyone with a chronic condition, I travel with my own pharmacopeia, which largely fills a separate overnight bag with the pills, solutions, salves, and devices that treat the cancer, various side effects, and the usual complement of conditions, such as high blood pressure, that seem to come with aging. My rattling bag of pills is a necessary nuisance. I wondered until today if it might cause some holdup at airport security. Happily it did not. You see, I am flying for the first time in many months.

A couple of weeks ago I celebrated my sixty-eighth birthday. This trip is an extension of that celebration. I’m writing this post on an American Airlines jet on the second and final leg of our trip south to sunny San Juan, Puerto Rico. Neither my spouse nor I has been to this destination. Technically we aren't leaving U.S. territory, and the Condado Lagoon resort will probably be more relaxing than adventurous. But it’s another step toward reclaiming my passion for travel. My spirit is already soaring as high as this airplane.

Postscript: The getaway was excellent!

Attitude

How does one live as though life will go on forever and, simultaneously, as if death awaits tomorrow? I ponder this question fairly often. The positions seem to be opposites, but actually both are facts of life for everyone. After all, neither is a certainty. No one lives forever, but it is self-defeating to live on the verge of death. Equally, except in rare cases and barring the unforeseen, most of us aren’t going to die tomorrow.

The diagnosis of a potentially fatal disease can quicken appreciation of the here and now. Today. Carpe diem, as the saying goes. That’s my answer to the question. It’s easy to get caught up in the grind of daily life and forget to step back and view each day through a longer lens and be grateful for the opportunity to live it. Some days the knowledge that my body is fighting cancer hangs over me like a storm cloud, poised to drench me in despair. I have a family tendency toward depression at the best of times, and such feelings can be hard to shake.

Readers who follow this blog may recall that I developed problems related to the targeted therapy drug Sutent, which I had taken since last spring but had to discontinue it a few weeks ago. I recently completed the first week on another targeted therapy drug called Afinitor. So far, the side effects have been fairly minimal; however, two have been irritating. One is that this drug increases my insomnia. Most of my adult life I’ve struggled with what is often termed “early rising insomnia.” I fall asleep readily enough but have difficulty staying asleep. Several of the days during this first week on Afinitor I have turned in about my usual time of 11:00 p.m. only to awaken around 3:30 or 4:00 a.m. to find it difficult if not impossible to fall back to sleep.

Another effect has been nervousness. Several days my nerves tingled for much of the day, which also made me aware that this drug tends to bring out minor muscle and joint aches. But it’s the jitteriness that is most annoying. Both that and the insomnia increase depression and lead to irritation and impatience, which I struggle to contain. Add in the cancer pain, managed (sometimes only barely) with a generic version of Percocet, and it can be challenging to step back and appreciate any given day. I like to turn that storm cloud overhead into an umbrella, but it’s not easy.

Three things help. First, being active. I try as best I can to set aside the pain, the jitteriness, the fatigue, and all the rest and just get on with living. Whether it’s writing, baking, painting, shopping, or some other activity, I find that doing something invariably feels better than doing nothing. Second, and just the opposite, purposefully doing nothing also can provide relief. Meditation, mild exercise, yoga—all turn the mind purposefully inward. Finally, being with family and friends, talking and laughing together, provides relief. All three of these things are distractors, of course. Dwelling on problems, fretting, projecting negatively about the future—these in themselves increase the awareness of pain and nervousness. Healthy distractions provide relief. This is something I’ve written about in earlier posts, but as I begin taking this new drug I needed to refresh my memory.