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Unexpected News at my 7-Year Oncology Appointment

^{(Title image: Photo by Gary Fultz on Unsplash)}

A few days ago I had my seven-year post-diagnosis appointment with my oncologist. Seven whole years. And it was a weird conversation.

He said something that set me aback. He told me that he didn’t think I should worry about the cancer coming back. Essentially, I was cured (note: MY words, not his, but that’s the idea). [See bottom of post for disclaimer!]

He’s alluded to this before during previous appointments. But this time around felt different.

I’ve officially hit SEVEN!
(Photo by Himiway Bikes on Unsplash)

I returned home a bit confused. See, for the last seven years, I’ve been a full-on cancer survivor. Still holding on to the fear that at any moment, I would get those terrifying scan results back and–WHAM–I’m a cancer patient once more, back on that sickening rollercoaster ride through treatment.

As difficult as it was to accept that–even trying my best to live a healthy life–I had somehow been smacked down by cancer…now, I had a new problem. Reentering life as maybe not-so-much a cancer survivor anymore, but rather just a healthy, active postmenopausal woman with years ahead of her.

And that is a weird feeling.

For the first five years after my diagnosis, I was frustrated, even angry. Cancer was a devastating detour at a time when I was already struggling to find my way back into a career. Well, forget that. Derailed. I was bitter.

Eventually, I realized that while life sucked, it sucked for a lot of people and I wasn’t special in that regard. That was an important turning point in how I perceived my own role in my cancer story–it was humbling but also gratifying.

Humbling because my experience could have been so much worse. There were people whose treatment did not end well. I was incredibly fortunate, even when it felt like I’d been thrown in a sack and beaten with sticks. At least, I made it out.

Gratifying because early on I held myself responsible for getting cancer, even though I had literally done everything protective (lots of exercise, high fitness, plant-based diet, breastfeeding, not smoking, not drinking) that I could think of. I was desperate with frustration and helplessness about this. Letting go of that guilt was healing.

Feels like I’ve got the green light to hurry up and get on with the rest of my life now.
(Photo by Possessed Photography on Unsplash)

So the last two years have been more about understanding my perspective and then stepping out of it to view things more objectively. Mindfulness and meditation helped with that, which is why I often write about them here. But I hadn’t been ready to get out of the breakdown lane and drive myself back into mainstream life, in part fearful of the pain of having the expectation of cancer-free “normality” smashed to smithereens by a potential diagnosis.

Gradually, that’s changed. But this last appointment felt like getting shoved out the door by someone yelling, “YOU’RE OKAY, DAMMIT!” Here I am, standing and blinking in the sunlight, trying to make sense of exactly what that means for me now. Wow, after seven years, I can actually stop being afraid.

I don’t know if I even remember what that feels like.

Yes, I’m still going to refer to myself as a survivor, because it’s a part of my natural history. I’m never going to forget that experience and I continue to be driven by a need to support others going through this disease.

And if it does return? Well, at least I will have had a brief glimpse of life completely outside the notion of cancer.

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Of course, because we’re talking about cancer, the statements above call for level-headness in the midst of levity. While my oncologist feels that the chances of the same cancer coming back are low, the possibility for a brand spankin’ new tumor, breast or otherwise, never goes away. It happened once, it can happen again. But that’s life. I’ll take it.

“Moving Through Cancer”: A Short Film from ACSM

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I’ve been coming across a lot of interesting–and hopefully useful– videos. The one I’m posting here is presented by the nonprofit Fund for Sustainable Tomorrows and the American College of Sports Medicine, the latter being the organization through which I received my personal trainer certification almost 16 years ago.

This is a 20-minute film with a hopeful message!

The film, narrated by former Olympic figure skater and cancer survivor Scott Hamilton, showcases the stories of how survivors are using exercise to make themselves feel better and increase their chances for survival. It also shows how our knowledge about physical activity’s benefits during cancer treatment has increased, and the programs that have been created to help cancer patients become and stay active.

It’s amazing to see how within a decade or two the attitude about cancer and exercise has changed. Whereas individuals undergoing cancer treatment used to be told to rest as much as possible, now it’s understood that exercising through your treatment is one of the best ways to not only minimize associated side effects but also decrease the chances of cancer recurrence.

For me, exercising during my treatment was a way to feel normal when everything else felt out of control.

The current recommendation is aerobic activity for 150-300 minutes per week along with twice weekly resistance training sessions. And it’s best to do both types of exercise for a well-rounded program, if you can manage it.

But the most important thing to remember is that no matter what you do, doing something is better that doing nothing. Research has discovered the existence of myokines, hormones that are produced in the tissue of skeletal muscles. They are released during muscular contractions and seem to have anti-cancer properties, slowing cancer growth and spread. That is very exciting news!

Of course, exercise is not a cure, and there is no guarantee that if you are an avid exerciser you won’t get cancer or won’t have it recur. However, there’s a very good chance that physical activity will make you feel better and help you continue with life-saving treatments.

As E. Ronald Hale, MD, MPH, Medical Director of Radiation Oncology at Kettering Health states (from the video), “The best cancer treatment in the world is useless if you can’t get through the cancer treatment.” The side effects from cancer therapies can be debilitating, but getting out and moving will improve your quality of life and help you finish your treatment.

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It’s worth mentioning that the number of exercise professionals who have had additional training in working with cancer patients is growing, which means that cancer-informed trainers and yoga teachers are becoming easier to find. Now it’s the insurance companies that need to get on board.

yoga4cancer: Bringing the Benefits of Yoga to Cancer Patients and Survivors [VIDEOS]

(Title image: Photo by Zoltan Tasi on Unsplash)

In February 2022, I started a yoga teacher training program with a singular goal: to eventually teach yoga to cancer patients and survivors.

With its mix of physical postures (asanas), breathwork (pranayama) and meditation, yoga is ideal for someone going through the traumatic experience that cancer can be. Yoga can provide enough physical exertion to count as moderate exercise and the ability to help the practioner calm their mind, things that are so important for improving cancer treatment outcomes. However, classes must be designed carefully and taught thoughtfully.

Yoga4Cancer Q&A for Cancer Patients and Survivors (Yoga Alliance on YouTube)

Keep in mind, yoga teachers were yoga practitioners first. Many of them got really good at the practice, developed great flexibility and balance and gained respect for the tradition of yoga. But that doesn’t automatically make them appropriate yoga teachers for cancer patients, who need an instructor that understands the nuances of what cancer is and how treatment affects us.

A yoga teacher and breast cancer survivor by the name of Tari Prinster addressed that need by creating yoga4cancer (y4c), “an evidence-informed Oncology Yoga method tailored to address the specific physical and emotional needs left by the cancer and cancer treatments. The approach matches breath and movement to stimulate the immune system, improve flexibility & strength, reduce anxiety and boost overall well-being” (from the y4c website).

I’m planning to begin the y4c advanced 75-hour certification program (see informational video here) either later this year or early next. I’ve been so impressed by y4c’s emphasis on understanding the unique situation that cancer patients and survivors are in–it’s not just your garden variety beginner yoga class with “also for cancer patients” dressing. The program is well-thought out and comprehensive, and I’m so excited to embark on this next leg of moving closer to my teaching goal.

In the meantime, here is a selection of videos created by Tari and her instructors that are specifically geared for the mental and physical needs of cancer patients and survivors:

Yoga4Cancer Oncology Yoga for Cancer Related Fatigue (Yoga Alliance on YouTube)

Yoga4Cancer Yoga for Bone Loss (Yoga Alliance on YouTube)

Yoga4Cancer Yoga for Range of Motion (Yoga Alliance on YouTube)

Yoga4Cancer.com Yoga for Anxiety (Yoga Alliance on YouTube

yoga4cancer.com Yoga for Lymphedema (Yoga Alliance on YouTube)

yoga4cancer.com Yoga for Constipation (Yoga Alliance on YouTube)

Enjoy!

Effects of Diet and Exercise on Chemotherapy Tolerance and Efficacy: Research

(Title image: Photo by Hermes Rivera on Unsplash)

Many cancer patients complain of feelings of helplessness after their diagnosis, and I can certainly relate to that. As a result, I’m particularly interested in research that explores whether patients can gain control over the success of their treatments.

The most recent study I’ve come across includes breast cancer patients undergoing treatment at Yale and Dana Farber Cancer Centers.

This study appeared in the Journal of Clinical Oncology (Sanft et al., 2023). Researchers examined the effect of diet and exercise on “relative dose intensity” (RDI), which is the relationship between the amount of chemotherapy delivered to the patient compared to the standard amount prescribed. Low RDI means that there was a reduction in the chemotherapy the patient received and is generally associated with a poorer outcome. Dose reductions result from the patient’s difficulty in tolerating the drug.

The researchers also looked for “pathologic complete response” (pCR), which is “the lack of all signs of cancer in tissue samples removed during surgery or biopsy after treatment with radiation or chemotherapy” (definition from cancer.gov). This was for women receiving neoadjuvant chemotherapy, which is chemotherapy administered prior to surgery.

Yep, once again we come back to diet and exercise, even during chemo.
(Photo by Yulissa Tagle on Unsplash)

The subjects of this study were women recently diagnosed with stage I-III breast cancer, who either received the “usual care” or a diet and exercise intervention. Those in the intervention group received nutritional counseling with a focus on a plant-based diet. The physical activity included counseling and support for maintaining a home-based exercise program that included strength training (2x/week) and brisk walking (150 min/week of moderate intensity or 75 min/week of vigorous intensity).

What the research confirmed first was that the subjects in the intervention group were able to increase their exercise and diet quality, which showed that it was feasible to make lifestyle improvements even in the midst of chemotherapy.

However, in this study, the RDI for both groups (“usual care” and diet & exercise intervention) ended up being similar, but also quite high, which meant that women in both groups completed most of their treatment. The researchers noted that the study should be re-run with patients who were at greater risk of not being able to complete all their chemo to see how much of an effect improved diet and exercise would have, especially since exercise has been shown in other studies to have a positive effect on patient outcomes.

But a striking difference was seen for women receiving neoadjuvant (prior to surgery) chemotherapy in that the rates of pCR (disappearance of cancer in the tissues) were 53% for women in the intervention group versus 28% for women receiving usual care. That suggests that the intervention enabled the chemotherapy to be more effective.

There are many physical activities you can choose from–clifftop not required.
(Photo by Sigmund on Unsplash)

The researchers stated the following in summarizing their study: “Given that pCR is an accepted predictor of recurrence and mortality, our findings could provide oncologists with a supportive care intervention that affects the ability to potentially improve survival outcomes” (Sanft et al., 2023, J Clin Oncol). And this is very good news indeed.

The take-home message here is not surprising, and it’s good advice for life in general: no matter what your current lifestyle, prioritizing a healthier diet (emphasis on whole foods, plant-based, less processing, etc.) and engaging in regular cardiovascular and strength training exercise will improve your quality of life. It is always worth the effort.

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REFERENCE:
Sanft et al. (2023) Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study. J Clin Oncol, 41: 5285–5295. https://doi.org/10.1200%2FJCO.23.00871. [This paper is Open Access and can also be found in PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691793/]

February: A Great Month for a Diagnosis Reenactment

(Title image: Photo by Aaron Burden on Unsplash)

It’s February and that means it’s the start of “diagnosis season” for me. At this point in cancer survivorship, I don’t get as affected by everything that happened “on this date X years ago“. However, I have an oncologist appointment and my yearly 3D mammogram around this time, so I can’t forget what this month means.

You would think that since 2024 marks seven (!) years since my initial diagnosis, I’d feel pretty good about having made it this far past my treatment…and you would be right.

Seven years down and still going strong!
(Photo by Frankie Lopez on Unsplash)

I’m now living the feeling that I so desperately wished for seven years ago when everything felt devastating and out of control. My outcome, even with the many pesky moguls that I’ve had to clear, is something I’m so thankful for.

But of course, even as mellow and relatively unconcerned as I am now, there are little reminders of the rough and tumble past that unsettle me.

Like that point in my mammogram when the tech finishes up and leaves the room to consult with the radiologist, and all of a sudden I don’t feel great anymore. It’s maybe 5-10 minutes or so of sitting in a quiet room all by myself, wrapped up in that bathrobe-y gown made out of fabric that seems like it should be less scratchy, trying to focus really hard on the tropical ocean video that they have playing on the tv screen on the wall.

No matter how warm the room is, there is a cold spot in the pit of my stomach. The hospital does its best making the surroundings seem inviting. Really they try. But it’s kind of hard to mellow out the echo of an impending sense of doom.

Same goes for every time my oncologist says something like, “Hmmm, should we do another chest MRI?” No, no we should not. That’s about 45 minutes of being stretched out like superman on a surface that’s clearly meant for a woman much shorter than me, while getting my ears blasted.

In case you’ve never taken a ride in the tube, this is what it’s like. Don’t forget your earplugs. Bonus for chest MRIs: you’re lying on your belly with your arms stretched past your head for almost an hour, giving you plenty of time to reconsider your life choices.

My husband says the MRI sounds like a broken dot matrix printer. I think if your printer is making sounds like that, it’s time to evacuate the building.

Ah the memories. But again, I am talking about this from the vantage point of seven years away. It is nicer being up here above the fray. It also gives me a great view of the potential rollercoaster disaster that this season could become, if my scans go south.

But seven years into this, I’m betting it probably won’t. So far, so good.

The Upside of Chemo Brain

(Title image: Photo by Jon Tyson on Unsplash)

As I’m stumbling through a bad cold, I got a reminder that you can find good stuff in bad situations.

Let me see if I can string this together somewhat coherently…

The cold I have came with an eye infection (relax, not posting pics!) that makes me light-sensitive enough that I need to be chauffeured around. Went to the doc last week, got a prescription for eye drops, then swung by to do some shopping, which I needed to wear sunglasses for.

And as I’m picking my way through a busy Costco, I’m holding onto a phone that I just bought–has a case but no screen protector yet–and I’m really worried that I’m going to drop it or lose it if I get distracted.

And why do I get distracted? Because anxiety and a touch of chemo brain (aka Cancer-Related Cognitive Impairment (CRCI)) have a summative effect that makes me loopy. Not a “scare-your-children” kind of loopy, but a constant “what-was-I-just-doing” kind of loopy. Over and over and over again.

I’ve been dealing with this over the past couple of months while juggling stressors. My eye infection introduced a new wrinkle–I am very much a visual person and use visual cues to manage the anxiety/CRCI problem.

But the good news? The Memory and Attention Adaptation Training (MAAT) classes I took for managing CRCI focused on mindfulness as a way of dealing with the lapses in memory.

And when I was in a Costco bathroom stall, I realized that I was acutely aware of where all my things were–purse on the door hook, phone on top of the toilet paper dispenser. I was ALL THERE and 100% present. I couldn’t afford not to be.

Not an earth-shaking revelation, but it was another reminder that there are all sorts ways to ground ourselves in the present. If I hadn’t taken the MAAT class I don’t think I would have felt so confident that what I was doing (being mindful) would work so well to help me stay focused and aware.

So, yes, I can be grateful for chemo brain for that.

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Today my vision has improved to the point where I can tell that the kitchen floor is really dirty, and that is most unfortunate indeed.

Bringing Calm into Healing Spaces: Shushing the BEEP with Yoko Sen

^{Title image: Photo by Adhy Savala on Unsplash}

After I was diagnosed with cancer, one of the things I dreaded the most was having to spend time in the hospital. I’d broken my leg when I was 12 and the four days (and nights) that I was hospitalized were horrible. I was depressed and wanted to go home.

As a cancer patient, I wanted nothing to do with all the beeping and buzzing medical equipment. While all my treatments ended up being out-patient–which I was sooo happy about–I spent enough time in the vicinity of medical devices to hear my share of annoying beeps. In fact, that was the last thing I remember before losing consciousness before my surgery…and the first thing I heard when I awoke.

Last time I checked, BEEP BEEP BEEP was *not* a soothing sound.
(Photo by Richard Catabay on Unsplash)

Apparently, I’m not the only one who dislikes the incessant jarring noises of hospital equipment. I recently had the pleasure of attending a webinar with Yoko Sen of Sen Sound, an electronic music artist who has worked with hospitals and medical device manufacturers to address the issue of disruptive noises in an environment that’s supposed to be conducive to healing.

The whistles, beeps, buzzes and alarms are anything but.

Yoko spoke about the stress levels of both patients and medical staff as being affected negatively by this noise pollution. Patients cannot rest and recover. Caregivers are constantly on edge about what piece of equipment is alarming. This is not an insignificant problem as at least in one case, a death resulted from a healthcare worker shutting down a patient’s alarm by their bedside in an effort to make the surroundings more soothing for them, and mistakenly silenced their entire alarm system.

Staff speak of “alarm fatigue”, when everything’s constantly alarming that dire situations are missed among the cacophany that is the hospital situation. The sounds follow healthcare workers home, like echoes that never go away.

Yoko herself was hospitalized some years ago and described the onslaught of noises as terrifying. So as a musician, she set out to help hospitals reduce unnecessary noises and then make the necessary sounds more pleasant while still remaining informative.

The talk was excellent and interactive as she let the audience vote on the different “textures” of sounds. Interestingly, we discovered that past experiences can significantly color the way that we perceive a sound. Yoko’s entire talk was both entertaining and eye-opening. Unfortunately, I do not have a recording of this particular webinar that I can post, but below is one of the videos about her work.

Yoko Sen is bringing beautiful sounds into the healing environment.

I love that not only is a musician looking for ways to make the hospital experience more, well, hospitable for both the healthcare teams and patients, but also that hospitals and device manufacturers themselves identify the stress caused by all these noises as an issue to be addressed.

One of the complaints that’s often voiced about western medicine is that it focuses on disease rather than prevention, on sickness rather than healing. This is a great example of efforts being taken to change that.

Finding Calm in a Matcha Tornado [VIDEO]

Following up on last week’s post on taking a coffee break, I’m sharing my daily matcha experience with you.

During my workday, I need to stop periodically and ground myself so I don’t get sucked into a hectic hole. And for me, there’s no better way to do that than to stand up, walk around to get some movement into my body and extra blood flowing to my brain…and head to the kitchen to make a matcha latte.

There’s nothing like taking a soothing break from my hectic day.

There is something about the process of making that tea drink that offers opportunities to focus on a soothing distraction that grounds me in reality. From pouring water into the tea kettle…scooping out the bright green powder…measuring out the water…whisking the solution into a brilliant verdant tornado…I find it so blissful.

This is reminder to there is more to my day than what shows up on the computer monitor. Those stressors will pass like a wave…new ones will arise…and those too will pass by.

Enjoy the swirl!

Coffee Break: A Mindful Start to Your Day

^{(Title image: Photo by Mindspace Studio on Unsplash)}

So, now that we’re a week into 2024, what a great time to set an intention for the New Year.

For me, it’s going to be “stress less and move forward”. At least I’ve got the “moving forward” part planned out, as there will be a lot of changes in my life this year.

It’s the “stress less” part that trips me up. So I’m redoubling my efforts to make sure that mindfulness takes priority in my daily activities, and one of the best ways to do this is to see how I can make everyday tasks into moving meditations.

I present to you, the coffee break. Tea works as well, even better, it could be argued. Regardless of your preference, this is how the break works (and obviously, this should be adapted to your own situation):

Wow, I can literally smell this image and the aroma is glorious!
(Photo by Mae Mu on Unsplash)

When you arrive in the kitchen (or wherever you keep your coffee, I’m not judging), bring your attention to your hands. Look at them. Notice the temperature of the air on them. Flex and straighten your fingers…and then observe your hands open the cupboard and remove the container in which you keep your coffee–mine is a metal cannister–along with a stack of paper coffee filters.

My cannister is has a pretty blue and green pattern on it and it feels cool to the touch, nice and smooth. As I open the top, the scent of coffee fills the air. I savor that for a moment.

Set the container down by the coffee maker and pick up a coffee filter. Mine is cone-shaped. Notice if the paper feels coarse against your fingertips and how it sounds as you handle it. Nestle it into place inside the coffee maker.

What does your running water look like, sound like, feel like?
(Photo by Nathan Dumlao on Unsplash)

Then, back to the coffee…and fish out the scoop (mine invariably gets buried under the grounds), spooning out however-much coffee you want. Listen to the “crunch” of the grounds as you do so.

Transferring the coffee into the filter may elicit more aroma during the process. What does it sound like as it falls onto the filter? When done, replace the scoop and then the top of the coffee container.

Whatever water container you user–mine is a plastic water jug, perhaps yours is the coffee carafe itself– bring that to the sink, place under the faucet, and turn on the cold water.

Does the faucet handle feel cool to the touch? As the water runs, notice whether light shines through the stream or if it’s aerated and fizzy. Listen to the sounds of water flowing through the plumbing and into your water container. Perhaps there’s a cool splash.

Such a peaceful start to the day. Inhale…
(Photo by Clay Banks on Unsplash)

When filled, turn off the water, noticing whether the handle makes a sound as you turn it. Bring the water container to the coffee maker and as you pour the liquid, listen to how it runs in, watching the waterline rise.

Close the coffee maker’s top, press the requisite buttons and savor the sights, sounds and smells of the coffee as it brews.

So as I mentioned above, depending on your own situation, your experience may vary, but the main idea remains the same: when you are in the process of making morning coffee or tea, be IN IT. Invite your senses to this event and, perhaps most importantly, keep unrelated thoughts out of it.

Start your day with a mindful ritual like this and it will help carry that attitude of staying present into the rest of your day. Give it a try and enjoy the calm!

Reflections on 2023; or “Focusing on What Doesn’t Suck”

(Title image: Photo by Kelly Sikkema on Unsplash)

Warmest wishes to everyone for a joyous start to 2024! I hope you had a wonderful holiday season with your loved ones and are ready to launch into the new year!

I…learned a few things about myself in 2023.

My family and I had our share of misfortunes, bumps and hiccups and stumbles that started piling on. An apartment flood, two sizable rent increases, physical pains, emotional turmoils, family illnesses.

It’s easy to focus on the negatives (and *ahem* trust me, I did many times). But there were also some significant positives this year, not the least of which is that my cancer has not returned and I am still alive. Those are two biggies.

But I also found myself somehow managing, even in the midst of the worst stressors. I didn’t respond the way I had in the past, which would have been with a bought of nausea, racing thoughts and tortured nights.

So I know that something has changed: there is actual space between me and the things that suck. Now, there’s not always a lot of space–occasionally it’s a teeny gap that you could only slide a credit card through. And at those times, I might not even remember to take three deep breaths. But when I come to my senses I can breathe more space into that gap.

You need to stop and reflect on how far you’ve come to understand the benefits of what you’ve been doing.
(Photo by Alexander Milo on Unsplash)

That, my friends, is called progress.

And as frustrating as it is that anxiety sometimes gets the best of me, my reaction is still so much better than it used to be and that provides motivation to stay consistent with a meditation practice.

So, if I learned anything, it’s that you don’t know how far you’ve come until you look back at the road you’ve been on and reflect on where you started.

But I also learned something else this year: sometimes you need to back off in order to go forward. I dealt with body pains that affected both my strength and conditioning exercise and yoga practice. I fought against taking it easy because I was so afraid of “falling behind”.

Well, nothing good comes of that. If anything, it prolongs recovery.

I was pushing myself to train harder and not respecting my changing limits. At the same time, I was juggling several online classes because I was also afraid of falling behind career-wise, on top of which I was concerned about finding a new apartment.

This was a classic case of spreading myself thin.

Constant striving made it impossible to my body to heal and rest and for my mind to assimilate information and construct useful goals and plans.

It was not until late December that I was forced to prioritize my well being because it hurt too much not to. Stressful events that came in the last quarter of the year gave me no choice. But in doing so, pain in my hip improved significantly and in backing off my expectations, I opted to focus on a single class, while at the same time continuing to sort through our belongings and get rid of things that we no longer need.

I slowed down and made more progress than if I had continued beating myself silly.

Look at all the beautiful positives that show themselves when you focus on the good stuff.
(Photo by Kim Stewart on Unsplash)

All in all, as frightening as 2023 was at times, I can see all the good that took place, and that’s the third thing that was a major revelation for me. I’d describe my view of the world as being like a picket fence. Sure, if I only look at the pickets I see the negatives that have taken place. But adjusting my focus on the the world that is visible between the pickets, it becomes clear that there’s so much more that hasn’t gone wrong.

Even when it seems that you’ve suffered so many setbacks–and it felt like I really stumbled during the second half of the year–when you review what DID work out, the sense of gratitude and relief is uplifting.

So even in the midst of everything that stressed me out, 2023 doesn’t seem so bad afterall. And that little burst of positivity is what I’m taking into 2024 with me.

Happy New Year!