Weighing on My Mind: Not the Scale Again!

Anyone who’s been through cancer knows that the experience is not just about the cancer. The entire journey involves much more, revealing even the little anxieties that had been tucked away in dark corners.

One of those for me was that I was constantly put on scales. EVERY single doctor’s visit, I was weighed. And I hated it.

It’s worth mentioning that I don’t have what most people refer to as a “weight problem”. Unless, that is, you mean being exceptionally diligent that I not put on weight. For me, weight was tied to self-worth, and in my perfectionist view, I was driven by fear of shame to keep my weight down.

At every single (frequent!) oncologist visit: “Step on the scale and I’ll get your weight.”

Ironically, the positive side effect of this was that I became very interested in exercise and healthy eating, and that has served me well. But of course, it took a long while for all of this to shake out into a truly healthy mentality, and particularly in my teens and early 20s, my mindset was not the healthiest.

By my 50s, however, I had a great relationship with my active, healthy lifestyle.

And then I got cancer.

And all of a sudden, hospital scales were all over the place, and even not being overweight, I sweated the weigh-ins. I sweated them when I first went to see my doc about the lump, when my weight started plummeting even before my first chemo infusion (hello, uncontrolled anxiety) and when post-infusion I was retaining water and my weight crept up.

I could write an entire post (or several!) about how, while I religiously weighed myself twice a week at home, I had intentionally put off several doctor’s visits over the years NOT because I was 10-20 pounds over a reasonably healthy weight…but because I was about three pounds higher than I felt I should be. Those three or four pounds would have disappeared on my 5’11” athletic frame, but that was beside the point.

There was an “acceptable” number and I wanted to make sure I was there before heading to the doctor.

The number of cancer visit weigh-ins was staggering. Every.single.time I saw the doctor (which was a lot), I had to hop on the scale. I would purposefully not drink very much water or eat less beforehand. It DID NOT EVEN MATTER that we were dealing with a life threatening illness. I absolutely hated getting weighed in a doctor’s office and I hated what the scale meant to me – that I was somehow never good enough.

Since adopting a spirit of mindfulness, my perfectionism has softened and I no longer abhore the weigh-ins like I used to.

I had internalized that belief.

Gradually, the number of weigh-ins decreased. It was as if a pot that was at full boil slowly simmered down. My mindfulness practice showed me not only that anxiety was not a helpful reaction to a stressful situation, but that the slight weight fluctuations that I obsessed about weren’t apparent to anyone else. Nonetheless, I had taken them to be indicative of yet another way that I felt I had fallen short of the person I “should have” been.

And that helped me understand and begin to deal with those unreasonable and even meaningless expectations I had of myself that were still lurking in the shadows.

So now, when it’s time to go to the doctor, do I fret the scale?

Well, I still feel that twinge because it’s a deeply-ingrained habit, but now I understand where that twinge comes from. And once I get off the scale, I forget about it and go on with my day.

Another Oncology Appointment…and What’s Up With That Smell?

My oncologist appointment last week marked five years since completing my final chemo infusion (and for those of you keeping track, since I had that nasty chemo nail infection).

Lately, my oncological appointments run like this: my onc asks how things are going, I air all my grievances and we spend the rest of the visit agreeing that there’s no way to determine whether what I’m experiencing is chemo-related, menopause-related, or something that I was dealing with before but hadn’t paid attention to back before cancer.

Because there’s nothing like cancer to make you acutely aware of every twinge and creak in your body.

But that’s about it. We are running out of things to talk about. In this context that’s a good thing.

I used to lament “what could have been” had I not gotten cancer, not experienced chemo, not been pushed into menopause chemically and artificially had my estrogen levels squashed. But now, I know better. What happened, happened. And “what could have been” is pointless to ponder because it simply isn’t reality.

It took me a while to get to that place and I’m finally okay with it .

But there was something else different about this oncology visit…

I walked into the cancer center for my appointment and was hit with “the smell”. There is a distinct scent in the building, possibly the cleaning solutions used to disinfect the place or maybe a fragrance that is purposefully pumped in. I had mentioned it to my clinical counselor several years ago and she admitted that a number of people have said the same thing. The smell is familiar, given that after multiple appointments and infusions and radiation sessions, I’ve experienced it a lot and have made many associations with it.

But for some reason, this time it hit me hard and a wave of sensations washed over me. Not sure why my reaction was so strong, but I’d like to think that between my last onc appointment and this one, I’ve made the most progress in distancing myself from the frustrations of getting cancer and have actually moved on with my life.

However, that rush of emotions served as a reminder of everything that I’ve been through over these past five years. I thought that chemo was going to be the hard part. Turns out, it was the most predictable part: six trying infusions, but they came with an end date. The rest of treatment brought uncertainty and unexpected difficulties. I thought I was done after radiation…but the pills continued.

Looking back at this, while I’m technically not “out of the woods” and may never be, these last six months have felt different. Yes, I still have another onc appointment half a year from now, but I’m finally turning my face forward to the future instead of constantly looking back at the past, worried that those frights will catch me again.

Extending Life with Immunotherapy: Advances in Treating Triple-Negative Breast Cancer

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.

Sources: Cancer.gov, Cancer Currents blog

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.

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REFERENCES

Cancer Currents Blogs

Sacituzumab Govitecan Approved for Metastatic Triple-Negative Breast Cancer, Cancer Currents, May 28, 2020: https://www.cancer.gov/news-events/cancer-currents-blog/2020/fda-sacituzumab-govitecan-triple-negative-breast-cancer

Sacituzumab Govitecan Earns Full Approval for Triple-Negative Breast Cancer, Cancer Currents, May 12, 2021: https://www.cancer.gov/news-events/cancer-currents-blog/2021/sacituzumab-govitecan-tnbc-regular-approval

Pembrolizumab Improves Survival in Advanced Triple-Negative Breast Cancer, Cancer Currents, August 9, 2022: https://www.cancer.gov/news-events/cancer-currents-blog/2022/pembrolizumab-triple-negative-breast-cancer-improves-survival

KEYNOTE-355 Clinical Trial
(as of this posting, the full article is not yet available to non-subscribers)

Cortes et al. (2022) Pembrolizumab plus Chemotherapy in Advanced Triple-Negative Breast Cancer. New Engl J Med, 387, 217-226. 10.1056/NEJMoa2202809

The “Side Effects” of Yoga Teacher Training

I’ve shared that I recently completed a three-month, 200 hour Yoga Teacher Training (YTT).

My main motivation for entering YTT revolved around yoga’s role in my emotional recovery from cancer. My teaching goal is to make yoga accessible to more cancer patients and survivors. Sadly, the view that many have of yoga in the USA is that it’s mainly for young, white, flexible, affluent women.

That means that the benefits of yoga are not reaching many of the populations that need it most.

Sadly, yoga in the USA is not associated with a diverse clientele.

In YTT, I expected to deepen my own practice, immerse myself in the roots of yoga and gain experience in sequencing and teaching among other things. And we did that. The program was well-rounded and paid homage to yogic philosophy, in addition to covering a broad range of relevant topics such as anatomy, meditation, sound healing and creating an inclusive atmosphere.

What I didn’t expect was what I learned about myself. Now, in the course of cancer treatment I gained access to counseling at my cancer center with an excellent therapist. And prior to that, I had sought help for anxiety. I’d explored talk therapy, cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), mindfulness-based stress reduction (MBSR) and had gone through a lot of introspection. Basically, I thought I’d covered my bases and knew what’s what when it came to my inner workings.

YTT proved me wrong. I learned that I still struggle with competitiveness, perfectionism and a host of little insecurities. Wow, that was an eye-opener, even after all the “head work” that I’d done! In addition to coursework, YTT had a requirement of attending a number of yoga classes. Due to the limitations on my time given my work and family schedule, I was forced to take the heated (~95F) Level 2 classes, which happened to be most convenient. They emphasized balance and flexibility, while my non-yoga fitness focus has been strength and endurance.

*ahem* This is NOT me.

Balance and flexibility against the backdrop of neuropathy, menopause and vestiges of cancer treatment effects did not allow me to show my “best side.”

Not a big deal, I thought, since yoga for me is a mental “work-in”, not a workout. I’ve felt that holds truer to the traditional purpose of yoga and respects its roots. But in a crowded yoga studio where I was usually the oldest class member, I struggled to maintain my composure. Many of the other students could have been my offspring. The Level 2 classes made me look, I felt, like I didn’t belong.

And that feeling got worse as the classes went on. By the last weekend, I was the only teacher trainee who showed up (others trainees had more flexible schedules that allowed them to take other classes). After weeks of taking Level 2 classes, feelings of dejection had built up.

I should be over this, right? I should have been able to hold my head high and do what I could, knowing that my fitness stemmed from other activities and yoga served a different purpose for me than for “the youngsters”.

But nope.

The YTT itself was exceptional and the teacher trainers were amazingly supportive and knowledgable. The other members of my class were (no surprise) all white, all female and all younger than me. But they were generous and sweet and each one had been through her share of hardships. I felt only love from them. I just didn’t feel it from myself.

This is my preference for yoga: slow , mindful movements performed with intention. No contortions.

And with fitness being so important to me, I was frustrated that yet again I managed to find a situation where I showed myself to be “less than”. That was painful.

Yet, this peek into my current state was invaluable. Being in the midst of all those younger bodies strengthened my resolve to create classes that are more suitable for not only cancer folk, but also for other special and older populations.

YTT taught me that I don’t have it all figured out yet. However, it also gifted the awareness of what was really going on. Just as in mindfulness meditation, once I became aware of where my mind was leading me, I could take action to return to a place of peace and acceptance. That advanced my emotional evolution by lightyears!

Experiencing classes at a yoga studio also drove home the necessity of offering yoga to people who would benefit from the practice but are often forgotten when classes are planned. There are populations for whom studios are simply inaccessible financially, physically and even psychologically.

Ultimately, this next-level awareness showed me that what I had been doing on my own over the years still counted as yoga, even when I didn’t look like the other class members. It was the yoga I needed. And that was enough.

A Reflection on “Chemo Fatigue”

After posting videos from my final infusion where I described chemo fatigue, I felt it important to follow up with a debriefing.

I was not in a good headspace during that time. I had started a mindfulness meditation practice five months earlier but had too little experience and not enough training for it to significantly affect my mindset, 50+ years in the making.

When I write a cancer-related post, I straddle a line. On the one hand, I want to provide an admittedly subjective and honest account of what I experienced during treatment; on the other hand, understanding that we all come from different backgrounds and may have vastly different perceptions of what cancer means to us, I don’t want to color the reader’s view of what their experience might be like.

Cancer revealed a lot more about myself than I expected to find.

There have been times that I held back on projecting too much of my own personal state. I waited five years to post my videos on Chemo Fatigue because I didn’t know whether it was appropriate to do so. They remain some of the rawest and truest representations of the despair that I felt at the time. I was still very angry and frustrated, feeling what I recognize now as a deep sense of betrayal.

It was mindfulness meditation along with deep reflection, expert counseling and simply the passage of time that ended up bringing me out of the anger. That process took a lot longer than I ever expected. It also showed me aspects of my personality that I hadn’t understood before because I’d never had to confront them.

So while I still would never say that cancer had a positive effect on me, just as with many heavy life experiences, it took me to a new level of maturity and self-awareness. I am very thankful to be on this side of treatment, although I’m acutely aware that everything may change with the next scan. That makes every moment all the more precious.

Chemo Fatigue: What Is It Like? [video]

[IMPORTANT: Please be aware that at the time the videos were filmed, I was in a very negative headspace. My experience should not be considered an example of a “typical” experience because with cancer treatment, there is no such thing. Just as cancer is a disease specific to an individual, so is the treatment and, as a result, one’s response to it. If you are interested in viewing the below videos, please keep all the above in mind.]

I’ve posted quite of few photos of my cancer journey. You’d think I wouldn’t have any more pics left, but–surprise–I do!

I made some important (to me) videos after my sixth and final infusion, but to date I’ve hesitated to post them. In part, this is because I’ve tried to remain anonymous in this blog, but in the clips, you get to see my face. And it’s not a pretty sight.

I didn’t feel human.

I was the weakest that I’d been my entire adult life. My body was feeling the strain of multiple infusions of chemotherapy, I didn’t recognize myself in the mirror and my voice didn’t sound like my own. I was so sick and tired of this part of the treatment and wanted it to be DONE.

At this point, I wasn’t suffering that entire cascade of side effects that I’d experienced after my first chemo infusion, and I’d learned to better deal with what I did experience, and even what to do to avoid some of the side effects.

However, the fatigue I felt was far beyond what I imagined it would be. And it was coupled with constant background nausea, like a slow burn in my gut. This was a result of losing the rapidly-dividing cells that lined my intestinal tract; they were felled by the chemotherapy, collateral damage as the medicine killed off potential cancer cells.

Strangely, there were also times when I was actually quite hungry, but literally too tired to try to get something to eat. Even calling for a member of my family to bring me food required too much effort. Speaking took a lot of energy.

The final infusion’s side effects lasted the longest. A full week after my infusion I was still very unsteady and barely made it to work for a few hours.

It’s worth noting that this was pre-pandemic and I wasn’t properly set up for working from home. Were I experiencing chemo treatment now, I’d be able to get more work done…likely to my detriment, unfortunately, because I really needed that time away.

It took five years for me to decide that it was time to post these videos. Apologies if they get a little intense:

August 13, 2017 – Cancer fatigue, part 1
August 13, 2017 – Cancer fatigue, part 2

Cancer, “Why Me?” and Mustard Seeds: The Path to Acceptance

At some point in a cancer patient’s life, there are certain questions that tend to come up. The most likely one of these is why we were singled out to have such a serious calamity befall us.

I went through a long period of this. I mean, loooong. The early posts of this blog are filled with agonized questions about why cancer hit me even when, by all accounts, it shouldn’t have. I posted about not having risk factors and blah blah blah. I kept going around and around and around on this, stuck on a hamster wheel that wouldn’t stop.

I clung to the same ride, unhappy but not wanting to get off.

Allow me to stress: cancer is a serious illness. That is not to be taken lightly. Most of us, regardless of lifestyle, experience profound shock with our cancer diagnosis. It may seem that life is cruel and unfair (well, it is) and that we didn’t deserve to get cancer (well, we didn’t).

I struggled with anger and frustration for years. It’s both embarrassing and freeing to admit that.

Acceptance is a process. I thought I’d accepted my situation a couple of years ago, but in retrospect, I hadn’t. Some days I felt holy and zen-like, floating on my own little cloud, but it was a sham. I’d have glimpses of acceptance and then a wave of anger and resentment would wash over me and I’d be pissed off for another week.

I thought God hated me. A purportedly loving and merciful being allowed this to happen. It was hard to not think of cancer as a blow against my value as a person because of how I interpreted my situation.

It wasn’t until I stepped outside the confines of that type of thinking that I gained a different perspective. I posted about re-writing my life (basically, viewing the same experiences through a different, more positive lens) which provided a glimpse of another way to assess what had happened. And when I heard the retelling of an ancient Buddhist tale I finally understood what it meant.

Never seen mustard seeds? Here they are. Kisa, however, came up empty-handed.

What was that tale? It was “Kisa Gotami and the Mustard Seed”. In brief, Kisa Gotami’s young son dies and she is so distraught–not understanding why she would deserve such a painful experience–that she goes to the Buddha in hopes that he can bring the son back from the dead.

The Buddha agrees to revive her son if she can bring him mustard seeds from households where no one has died. Of course, she cannot because death touches all living creatures. She is comforted by the realization that her sorrow is shared and understood by everyone in the community and she finds acceptance of her loss .

Another way of looking at this is that we all suffer. For me, it’s a reminder that while a cancer diagnosis is life-threatening, there are few (if any) humans on this Earth who have not experienced some form of loss or grief at some point in their lives. Yes, some of us bear a far greater burden than others–grave inequities exist. But they also bring profound opportunities for growth.

And while I (and I expect most cancer patients/survivors) would have preferred to experience this personal growth through means other than cancer, being able to be here in this moment, having turned the corner, is one of the most beautiful gifts I could ever receive.

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Two points need to be made here:

Point #1: Burdens are distributed unequally. Socioeconomic, racial and other disparities further tip the scales, making outcomes from a disease like cancer even worse. As a society, we haven’t come close to rebalancing this. Acceptance is easier for some than for others; no one has a right to preach to anyone else.

Point #2: It’s been over five years since my initial cancer diagnosis, and even longer that I’ve been worrying about it. As I mentioned above, it took a LONG time to get to this point of acceptance. Knowing this, I would never rush a new cancer patient to get here. Acceptance must come organically, and yes, sometimes never does. Cancer breaks hearts and no one experiences it in the same way. Be patient.

It Took Cancer to Teach Me Self-Compassion

One thing I’ve had trouble with is expressing self-compassion. When you’re a driven perfectionist it’s easy to believe that “giving yourself a break” is tantamount to “going soft” and “losing your edge”.

I couldn’t forgive myself when I felt that I’d failed. And guess what, getting cancer made me feel like a failure. I had tried to live the healthiest adult live I could, given the sometimes-limited resources I had, often denying myself what others called “pleasures” or “indulgences”.

I’ve lived most of my life feeling like I had to constantly push myself…and that I was never good enough.

The fact that I was convinced that I shouldn’t have gotten cancer was a recurring theme early on in this blog–I was convinced that I must have done something wrong, even when I tried so hard to do my best.

I was also ashamed. Cancer, I felt, opened my life up to judgment by others.

Getting myself out of that funk took serious work. It meant rewiring my brain and allowing in the same kindness and compassion for myself that I allowed for others. At the same time, I reminded myself of a quote by author and humor columnist Dave Barry: “A person who is nice to you, but rude to the waiter, is not a nice person.” I prefer to interpret Barry’s words in this way: I cannot be genuinely kind and non-judgmental to others until I’ve learned to be so to myself.

Cancer gave me perspective to see how much I needed compassion from myself.

But how do you do that when you’ve spent your life pushing yourself, not accepting excuses? It wasn’t until I hit the lowest low that I ever experienced that I learned to dip into unadulterated compassion for myself. I imagined who I was as a chemo patient–skinny, bald, dehydrated, vulnerable, frightened. And suddenly felt it: that overwhelming desire to wrap my arms around that version of me and protect it.

And while that was “cancer me”, I realized that same version of me was the scared person inside that I had always bullied with perfectionism and accusations of not being good enough. This was who I really was, in need of and deserving of gentle holding.

It took a life threatening illness to make me realize that I deserved kindness and compassion. I believe that you are deserving of the same. Do something today to prove it to yourself.

The Benefits of Physical Activity During Cancer Treatment and How to Begin

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.

Permission to Grieve

I feel like I write a lot about loss when speaking of my cancer experience. That may seem like a downer, but truly, cancer treatment is a complicated process in more ways that expected. Bear with me for a few…

There’s so much to lose: lose control of your life, lose your hair, lose your lunch, lose a lot of money, lose time at work, lose your libido, lose your overall quality-of-life. In more extreme cases, lose your spouse and your house. And unfortunately, sometimes lose your life. On some level most of us may feel some sense of loss.

Cancer is complicated because it can bring on a huge sense of loss.

I keep talking about this because it’s not something that’s fun to talk about. Most people don’t know what to say when they find out you have cancer. They’re hesitant to say something to “remind you” of the illness, as if you could forget. Relationships can become strained and awkward.

Interactions with cancer patients often turn into a “rah-rah” fest, with well-meaning friends showering you with “you got this” encouragement. But that’s not always what you need to hear.

I urge everyone who cares about the well-being of a cancer patient to allow them the opportunity to express how crappy things are. To simply listen and not contradict them. Because being insistent that it’s not okay to talk about anything negative creates an even bigger sense of loss for the patient.

Does this sound wrong? We’ve been led to believe that being positive is the only way we should be and that it’s no fun to be around those who are gloomy.

But consider this: would you go to a funeral and try to get the grieving family to “cheer up”? Would you try to tell them jokes and elbow them into smiling? I don’t think you’d be very successful and might be escorted away – at the least your invitation to the meal afterwards would probably be revoked.

Forgo the cheerleading and simply offer an ear and a shoulder.

We know that behaving this way is unacceptable, at least in most cultures (I can’t speak for everyone). Grieving is an important part of the human condition and not being allowed to grieve loss can be very stressful and lead to problems down the road.

So it is for the cancer patient. There’s so much more going on than simply increased doctor visits and medical procedures. Minimizing the impact that this has on their lives may range from feeling unfair to devastating.

Of course, every patient is different and their reactions will differ too. But I would urge loved ones to err on the side of caution, give their cancer patient the time and space to process and grieve and save the exhuberant “cheering up” for a time when the patient seeks that out.

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Ok, ok, the “loss of body odor” is one loss that’s not so bad!