From what I can tell, the loss of body odor following cancer chemotherapy isn’t widely acknowledged within the medical community, but it’s certainly something that many of us have experienced.
This is NOT what you think of when someone says, “sweaty armpit”!
Based on what I’ve read, this might be a result of the weedwhacking effect that chemo drugs have on our microbiomes. Regardless, the result has been positive for those of us who find that we don’t have to worry about being smelly.
However, I happened to catch an interview on National Public Radio (aka NPR) that helped make more sense of what was actually going on, even though it was a bit of a killjoy. Listen to it here, where you can also find a full write-up of the piece.
Basically, that sweaty stink that we find repugnant is from a compound produced by bacteria living on the skin. One species of these bacteria that’s associated with an onion-like odor is Staphylococcus hominis.
Our stinky sweat may offer some protection from stuff like MRSA, shown on this CDC photo. They might look like cute fuzzy purple balls, but in the age of antibiotic-resistant bacteria, they’re potential killers.
And unfortunately, these smelly microbes are very beneficial, helping protect humans from things like eczema and MRSA (antibiotic-resistant Staphylococcus aureus). As one of the researchers puts it, sweat is an “antibiotic juice” that forms a protective layer on our skin as it dries.
Yeah, I know what you’re thinking: cancer is miserable enough, and you HAD to take away this one little thing (loss of body odor) that was the only perk to chemo?
Well, as mentioned above, I’m not qualified to definitively say that it’s the chemo that kills the skin microbes and makes you not smell. I’ve been unable to find research studies that examine the effects of chemotherapy on your skin’s microscopic residents. Nonetheless, I’ve tried to contact the researchers mentioned in the NPR story to see if they’ve had any experience with chemotherapy and loss of body odor in cancer patients. If they reply, I’ll report back to you.
For now, if you’re happy being odorless, keep enjoying it.
I’ve posted several times about different counting techniques that I’ve used to help calm and ground myself (counting backwards, counting 100 breaths). It sounds like such a simple thing, but it is surprisingly effective.
Counting is one of those things that we naturally learn when we are very young, and because it’s so familiar to us, we can do it with ease as adults.
Job #1 is to stop the swirling thoughts so that you can drop back to sleep.
This ease comes in handy when our Monkey Mind is jumping around like mad, stewing over what has happened or fearing for what is to come. Counting gives it something to do so that its attention is drawn away from anxious thoughts.
In particular, I’ve found this to be useful at night when falling back to sleep has been hindered by that incessant buzz of thinking that won’t go away.
The technique that I’ve used over the last few weeks weaves a counting pattern like this:
Become aware of your body lying in bed. Try to soften the most obvious places of tension (for me, neck and shoulders) and turn your attention to your breath.
Begin by focusing on your inhales of your breaths and counting them, up to ten. Then, switch your focus to your exhales, counting each one up to ten. And again, switch back to focusing on the inhales, continuing this way
The combination of counting up to ten and focusing on either the inhales or exhales provides enough of a distraction from your thoughts, but requires some gentle attention to keep on track. The switching of focus invites your mind to return to the breath.
Counting sheep might work just fine, but counting breaths helps you stay present and grounded.
I’ve found ten to be a very good number; however, five would also work. Whatever you prefer. This might require experimentation to see what is best for you. For example, counting to two might work better for some people during waking hours when there is naturally more stimulation around.
As you establish a pattern with your breath, extend your exhales regardless of where your focus is. This helps slow both your breath and heartrate.
Again, this technique works because counting to ten is simple and unstimulating, allowing the mind to lull itself into a calmer state. When I find myself missing ten and instead counting into the teens without switching my inhale-exhale focus, I know that I’m beginning to drift off. I gently stay with it, but sleep is nearby.
By now I’m probably sounding like a broken record about how important exercise is to all aspects of your life, but here I go again…
Although this is not specifically about cancer, an article recently published in the Journal of Aging and Physical Activity (Posis et al., 2022) scored another point for the benefits of maintaining an active lifestyle.
This study was conducted at the Herbert Wertheim School of Public Health and Human Longevity Science (University of California, San Diego), where the researchers examined the effect of physical activity/sedentary time on longevity in women. The 5400+ study participants spanned the entire range of genetic predispositions for longer or shorter lives. You can read a synopsis of the research here.
When in doubt, keep moving.
The results of this prospective study (2012-2020), while not surprising in the grand scheme of things, can be considered a wake-up call.
Regardless of their genetic predisposition, women who engaged in higher levels of activity had a lower mortality risk and those who were more sedentary had a higher risk. This is important, because it’s tempting to think that if your family members are long-lived, you will be too. However, your own activity levels do matter.
In addition, being physically active was effective in extending the lifespans even of those women whose genetics suggested a shorter life.
This can be considered promising news: you do have some control over your lifespan. Even when you’ve been dealt what may seem like a losing hand in terms of longevity or disease, providing your body with the supportive behaviors that it needs and deserves still makes things better.
It’s easy to forget this when we focus on the negatives in life. And while we do need to acknowledge our hardships and allow ourselves time to grieve for our losses, making choices that benefit our bodies and minds is a sign of respect for ourselves.
So go ahead, soak those tootsies…then get back outside for a walk. And don’t stop.
Unlike a glass of wine or a rich dessert, commonly considered an “indulgence”, self-care in the form of moving ourselves, step by step, day by day, closer to a healthier lifestyle is the kindest, most loving indulgent act you can ever do for yourself.
What one little thing can you do today that you didn’t offer to yourself yesterday that will move the needle further towards a more active life?
Posis et al., (2022) Associations of Accelerometer-Measured Physical Activity and Sedentary Time With All-Cause Mortality by Genetic Predisposition for Longevity, J Aging Phys Act, https://doi.org/10.1123/japa.2022-0067.
The August 9, 2022 edition of the National Cancer Institute’s Cancer Currents blog announced the findings of the clinical trial KEYNOTE-355 that examined the benefits of using the immunotherapy drug pembrolizumab (Keytruda) in conjunction with chemotherapy in treating advanced triple-negative breast cancer (TNBC).
The results, published in the New England Journal of Medicine (Cortes et al., 2022), revealed that pembrolizumab in conjunction with chemotherapy was effective in extending the lives of TNBC patients with advanced disease as compared to chemotherapy alone, and the difference was striking. Those who received the drug lived a median of 23 months compared to 16.1 months for the chemo-only group.
Of course, cancer differs among patients and not all TNBC tumors are the same. The life-prolonging benefits of pembrolizumab were limited to those patients with PD-L1 scores of at least 10; PD-L1 is an immune checkpoint protein, and the score denotes the level of this protein found in cancer tumor cells.
And it’s important to note that while the drug extended life expectancy, it was not yet a cure, which is what we’re all still waiting for.
So there are asterisks associated with these findings, which might be disappointing for those with advanced cancers of this type. But the researchers stressed that this is a very promising outcome.
Consider the advances that have been made. TNBC used to be treated with untargeted therapies, kind of like throwing everything you’ve got at the tumor and hoping that something “sticks”. On the other hand, pembrolizumab is a targeted therapy for this specific subset of TNBC, and that makes a huge difference.
There has been a push to address the complexities of TNBC and large strides have been made in understanding what makes it tick. New therapies are being approved and they are making researches optimistic about eventually being able to cure the disease.
As an example, in April 2021, the FDA approved the use of sacituzumab govitecan (Trodelvy) for the treatment of certain types of TNBC (after conditional approval had been granted in April 2020). As noted in the May 12, 2021 edition of the Cancer Currents blog, sacituzumab is comprised of an “antibody coupled to a more potent form of the chemotherapy drug irinotecan (Camptosar). The antibody binds to breast cancer cells, delivering the chemotherapy directly to those cells.”
There’s good news for some patients with advanced triple-negative breast cancer.
Notably, patients receiving sacituzumab lived a median of 11.8 months longer compared to 6.9 months for those patients receiving the chemotherapy alone. Positive results were also obtained for patients with brain metastases, where the cancer has spread to the brain, who tend to have worse outcomes when treated only with chemotherapy.
There is still so much more to learn. Cancer is a puzzle and researchers have known for some time that the pieces do not yet fit together cleanly. But each one of these advances brings us more effective treatments for TNBC, addressing more specific targets on the tumors. Lifespans are increasing and for many, cancer is taking the form of a chronic disease, not a death sentence.
Staying present is key for not letting your thoughts take you on a wild ride.
Maintaining presence, however, takes practice so I’m always on the lookout for new ways to imagine the state of being in the “now”. Some of these are simpler exercises than others, but the upside of a more “complex” technique means that all my mental energy remains on staying present instead of, say, worrying whether I embarrassed myself at a party three nights ago.
The following is a visualization and mental exercise rolled into one:
What if only what you’re touching exists and everything else falls into nothingness?
Seated, close the eyes. Breathing deeply, allow everything that is around you to fall away in your mind, leaving only those points where your body makes contact with the surface beneath you.
Imagine that the soles of your feet sit on top of sole-shaped pieces of support material. Your buttocks and thighs contact like-shaped material, as does any place your back rests against your chair. If you touch your fingers to the side of your chair seat, small oval-shaped pieces of material appear where your fingers make contact.
Everything else disappears against a background of light (or darkness, if that is more calming). The chair and floor and even the room you are in? Gone. The point of this visualization is maintaining focus on only what you are physically experiencing at any given moment.
It is a strange sensation to imagine, floating through the ether but still feeling support from the slightest bits of material that touch you. This is the ultimate in being 100% present and turns the concept of object permanence on its head.
You don’t feel it? It doesn’t exist.
Our brain wants to fill in the parts that we can’t see because the brain has formulated an image of what is out there. However, in this practice we try to do the opposite–let go of what we do not have immediate physical evidence for.
This is a good analogy for dealing with thoughts that our brain fabricates based on the expectations that it has. What if we let go of them, if only for a short while, and simply sit in the stillness of what is happening right now?
I, like so many people, keep a lot of tension in my neck and shoulders. Some days it feels as though my neck is made of steel, but not in a good way.
The reality is that I don’t even realize how tight those muscles are until I lie down and try to relax.
So I have made a meditation of this for bedtime. Instead of focusing on the sensation of my breath, the focus is on releasing the tension in my neck and upper shoulders.
It may sound like I would not be able to squeeze an entire meditation session out of this, but oh, I can.
Complete release takes focus!
Lying down on my back I inhale, and then with the exhale, I focus on my neck and relax it, releasing the rest of my body along with it. With the following exhale, I do that again. That’s because while I may think that the initial release took care of the tension, there is still tightness there and I really have to work on it mentally to release that.
It’s as though my neck muscles are springs that I can stretch, releasing tension through the exhale, but once I let go (inhale) the “memory” in my muscles tightens them up again.
It helps to imagine my body melting, as if I’m being drawn downward into the Earth.
I can keep going like this, feeling my chin inch slightly towards my chest as the tension releases. Melting into the mattress. The more I release, the more subtle the sensation, yet very satisfying. The more I relax, the more deeply I breathe and everything lets go.
The awareness of what is going on in my body helps so much, but the tension is tenacious. This is not surprising, given how much mental weight my neck and shoulders bear. So it is a dance between releasing and returning to release again. Little by little until I eventually fall asleep.
In my continuing quest to find ways to calm myself and soften anxious thoughts, I often resort to visualizations. They are effective in putting the breaks on distressing thought patterns, creating space and encouraging a broader perspective.
My clinical counselor offered the visualization I’m introducing here. It works similarly to “thought container“, which is a visualization in which you create a container for your stressful thoughts, put them in there, lock the container up and place it on a shelf.
You decide how you’d like your rocket to look. Serious and foreboding or cute and shiny?
However, this one goes a step further. For this visualization, imagine a shiny space capsule on a launch pad, of whatever style and era that suits you. Gather up your troubling thoughts and send them towards the capsule, marching them up the ramp and in through the door. You can wave good-bye as the thoughts enter and settle into comfy seats, safely belted in.
Your thoughts are not “bad”. They simply elicit negative reactions in your body. And right now you want to loosen their grip on you.
When all those stressful images are inside, close the airlock/door. It’s up to you how that’s going to look. Perhaps it’s a high-tech electronic door that shuts and locks remotely so you don’t have to be close by. Or maybe it looks like a massive bulkhead, with a wheel that you yourself physically crank shut and secure so that you can be sure that nothing slips out.
When the capsule is secured. Start the countdown to launch. Or just press a button and shoot it off into space immediately. You have full control here.
But here’s the thing: this is a visualization to create distance, not to completely eradicate those thoughts. Because that’s impossible. They will not simply disappear. However, you can give yourself a little break from them, which is what this lauch is about.
Your stressors are still there, but it’s easier to learn to deal with them from down here. Give yourself some space.
Where does the capsule go? To the Moon. It will rocket off the Earth and land on our satellite neighbor. Point your telescope at the Moon at night and you’ll see the capsule, knowing that those thoughts are there but far enough away that they don’t torment you. You’re not trying to forget about them completely. Instead, practice dealing with them where they’re not an in-your-face threat.
In this way, you don’t repress or avoid, you give yourself breathing space and the opportunity for calm.
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I admit that if you’ve been particularly beleaguered by stressors, it would be very tempting to treat the rocket like a clay pigeon and blast the whole thing to bits…and maybe there’s a great idea for a video game there. But truly, it may be easiest to handle them by releasing the thoughts into the ether.
Yes, they’ll be back. And so will the chance to take a deep breath and send them off again.
I have a problem. And if you’ve been reading this blog, that statement won’t surprise you.
My thoughts take me for a ride and it’s a wild one. I’ve gone from being perfectly calm one minute…and the next minute gesturing wildly, face screwed up, whisper-arguing with a person who is not there. I can feel agitation in my belly and an increase in breathing and heartrate.
The story takes off.
I have a solo argument with an invisible adversary. Sometimes it’s someone I know, rehashing past hurts; other times it’s an imaginary situation that my brain concocted, a fear of the future. Regardless, there is always some form of negative state change involved.
When my mind starts creating stories, it’s hard not to jump on board the train and get taken for a ride.
In the past, I would have barreled along like a runaway freight train, exhausting and unnerving myself. It became a habit, like an itch I needed to scratch. It was so hard to stop those thoughts once the train started rolling along.
Mindfulness changed that, but it took time to develop awareness. I learned to ask one very simple question of myself as soon I realize that I’m being swept away by that torrent of brain activity.
Three simple words: where am I?
This works like magic for me. It’s instant grounding.
That’s because the train screeches to a halt and I shake off the mental noise and look around myself. I’m usually somewhere alone. There’s often some far away street hum or something else not very intrusive. I feel where my body makes contact with whatever surface I’m on.
As soon as I poke my head out from the noise, I realize that I’m on the train. And I get off.
I am HERE. And in this moment, I am safe. Regardless of all the thoughts that suggest otherwise, I am safe.
It doesn’t mean that there aren’t problems that will need solving or work that needs to be done. But all that noise that was panicking me just a bit ago? I am reminded that it doesn’t exist right now. And right now is the only moment that matters.
Three simple words. Man, if I’d known this years ago, I could have saved myself so much heartache. But at least I know now. And now, so do you.
While this isn’t exclusively an exercise blog, if you’ve perused my posts you’ve probably noticed that I’m a huge proponent of exercise for both cancer patients and survivors (well, actually for everyone; but see my important message at the bottom of this post).
The best way to achieve this is to start exercising right now, if you are not yet, no matter what stage of the cancer experience you’re in.
There is a growing body of research that shows the benefits of exercise for cancer folk (I’ve written about it here). But the fact is that only about 17-37% of cancer survivors meet the minimum physical activity guidelines set out by the American Cancer Society (Hirschey et al., 2017, Cancer Nurs) even though doing so reduces the risk of cancer recurrence by 55%, not to mention the improvement in quality of life (Cannioto et al., 2021, J Natl Cancer Inst).
Exercise, the Cancer Fighter. In the not too distant future, your oncologist might hand you an exercise prescription as part of your cancer treatment.
Now, there is a call to include exercise as an adjuvant therapy for cancer for those who are currently undergoing chemotherapy. During the Oncology session of the 7th International Congress of the Spanish Society of Precision Health (SESAP) that took place in Spring 2022, Adrián Castillo García, a researcher at the Barcelona Biomedical Research Institute (IIBB) of the Spanish National Research Council (CSIC), reviewed recent studies regarding the benefits of exercise during cancer treatment, including the potential role that it had in “modulating the tumor microenvironment and immune function.”
You can read a synopsis of his statements here in the section entitled “Exercise as Oncological Therapy” (starting towards the bottom of page 2). Castillo states that physical exercise “has been shown to have the ability to modulate the tumor environment… . This modulating effect translates into an improvement in the efficacy of chemotherapy and other oncological treatments.”
Castillo goes on to say that “prescribing doses of physical activity at an established intensity and volume can be very decisive in combating the tumor microenvironment, but this preliminary evidence must be confirmed in trials on humans to ratify the role of exercise as a treatment capable of improving the efficacy of the main therapies.” (All quotes from the aforementioned synopsis.)
With such promising results, it’s quite possible that future cancer treatments may be a combination of medicine and physical activity.
Ok, so say that you are not an avid exerciser, but motivated by these studies you’re willing to give regular exercise a go. What do you do when you’re already feeling fatigued from treatments?
I wrote about this here, but in a nutshell, the idea is that you need to decide what the right starting point is for you, and this will depend on your previous experiences, both physical and emotional, with a physical activity program. It will also depend on what you can manage at any given time in your treatment.
Starting an exercise program? Make it something that you can do and enjoy, and it will become a life-long habit.
Ask yourself, “what is reasonable for me?” But don’t respond to that with a t-shirt slogan-type answer (“Exercise? I thought you said extra fries?!?”) that immediately shuts down the idea. Admittedly, there may be times during treatment that getting yourself to the toilet without help is a momumental achievement. But that will pass. And exercise will make you feel more in control of your health and better overall.
IMPORTANT: Find what you can do and then do it as consistently as you can.
This may mean starting very simply [always get your doctor’s okay first!]. Choose an activity, duration and frequency, say, brisk walking for 20 minutes a day, three days a week. Follow that pattern for two weeks, then add to it–perhaps another 10 minutes–not to overwhelm yourself, but simply to push the edge a bit (you can always ease off if you need to, give it a week and increase again). If possible, increase some aspect of your program every couple of weeks, as it suits your condition. In the example of walking, incorporate a flight of stairs and gradual upper body movements: first pumping the arms, then hand weights, eventually strength training for both upper and lower body.
The timing is up to you.
If a walking program feels too easy for you, train at a higher level, but remember that the same concepts still apply: (1) consistency, (2) progression, (3) balance in your activities. If you’re interested, read my post about my three “pillars” of fitness.
Most importantly, start, progress gradually and keep it up for the rest of your life.
If your starting point is a standstill, this will take patience. But I PROMISE you, no matter what you can muster, it will still be better than doing nothing.
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I know I already said this, but it bears repeating, especially for cancer patients and survivors: do not start any exercise program without consulting with your medical team first. While I feel that improving your physical fitness is one of the best things you can do for yourself, every body is different and every cancer situation is different. Talk to your doctor and let them know what you’re planning to do.
I came across a delightful mindfulness visualization on the Calmmeditation app, presented by meditation teacher Jeff Warren who credits his teacher, Dan Clurman, with relating the idea of this exercise.
It is an effective and immersive way to ground yourself into the present moment with the emphasis on being in your body.
Imagine that your body is an hour glass and that the falling sand brings awareness as it fills the glass, from the bottom up.
Imagine that you are an hourglass and your awareness is the cool sand that falls from above. First, bring your awareness down into your feet and ankles, feeling into the sensations there, filling up not only that part of your body, but also inviting attention into the space between your feet and around them at the bottom of the hourglass. Feel the level of your awareness rise.
Now invite your awareness to fill up your legs, while still keeping attention on your feet and ankles. Notice how the level of these “sands of awareness” travels up and fills out the space up to your hips. Feel into how that feels, not trying to change anything, but simply noticing any sensations.
In this way, continue to work your way upwards, allowing these “sands” to gradually fill up your body as they empty from your mind. Allow the swirling thoughts to release and drop down to light up your lower limbs, your entire torso, your arms and shoulders little by little. Maintain awareness of the parts of your body that have awakened already, so that as you move along in this way, the sensations in your body build and you feel the liveliness of the present moment in them.
Finally, coming to the top of your head, feel into all the sensations vibrating through your entire body, perhaps gentle tingling in your feet and legs or a subtle pulsing in your arms and hands. Maybe the awareness of movement through your intestines, the beating of your heart and even the areas where your body makes contact with the surface that supports it.
In this way, you bring the whole of your body into the present, not focusing on just one part, but on everything that makes up your physical presence, and also the space around your physical presence, while at the same time relieving your mind of the pressures exerted by thinking. As your body fills, your mind empties and thoughts are replaced by a sense of peace and well-being.
I’ve tried this a number of times and found it to be both grounding and uplifting simultaneously and an effective way to bring myself out of my head and into the here and now. If you’re looking for a different way of engaging in a body scan, give it a try.
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Please note that a form of this meditation appeared on the Calm app on April 29, 2022, as an installment of Jeff Warren’s Daily Trip.
While I am a subscriber to Calm, I do not receive compensation for writing about the app. I am simply a very satisfied user.
Frantic Shanti 