Tag: Cancer

Webinar: Recent Advances in Breast Cancer Treatments

As we close out October, otherwise known as “Breast Cancer Awareness Month”, I wanted to share a video of a webinar about advances in the fight against breast cancer, offered through the Yale Alumni Health Network, led by Dr. Jamie Wells.

The speakers included Dr. David Mankoff (from UPenn) and Drs. Lajos Pusztai, Maryam Lustberg and Eric Winer (all from Yale) as they talked about research being done on hormone-positive, HER2 receptor positive and triple negative breast cancers. I’ve pasted in the Vimeo clip from Twitter, but also offer my simplified synopsis below. If you have the time to watch (~45 min for the talks, then interesting Q&As for about 20 minutes), I highly recommend the video!

In the midst of the discussions, it was heartening to hear that the doctors placed a lot of emphasis on both health disparities in different populations and also the search for treatments that would not severely impact a patient’s quality-of-life. These are two important topics. I appreciated that they acknowledged that we cannot make advances in the disease if we are leaving behind large numbers of people for whom treatment is inaccessible, and that a treatment is not viable if it successfully treats the cancer but damages the patient in other ways.

The best overall news is that since 1990, deaths from breast cancer have decreased by a third. That’s a significant improvement within the past 30 or so years, even though the prevalence of the disease is increasing. Dr. Mankoff noted that the survival rate improvements are due not simply to earlier detection, but also to advances in the treatments.

HORMONE-POSITIVE BREAST CANCER

Dr. Lustberg spoke about hormone-positive breast cancers and started with a quick explanation of the history of such cancers, and then explained how current-day personalized medicine (genomic profiling) can identify the patients who might be spared chemo based on the characteristics of their tumors, and how targeted therapies improve survival rates. She experienced some audio issues towards the very end of her talk, but not much information was lost.

She acknowledged that the “most effective drug is one you can take”, stating that there’s been an effort to try to understand the toxicity of various treatments. If the drug’s side effects are too negative, patients will have a hard time continuing to take it. She noted the importance of keeping the patient involved in the decision making process, something that all of us who have been through this can applaud. It’s too easy for oncologists to forget that they’re treating a human being who will be dealing with the concequences of heavy treatments.

HER2+ BREAST CANCER

Dr. Winer discussed HER2-targeted therapy, noting that prior to the year 2000, it was considered one of the most aggressive forms of breast cancer with common recurrences, after which the prognosis for survival was poor. As a HER2+ cancer suvivor, I am so thankful that this is no longer the case! The landscape changed with the introduction of monoclonal antibody drugs such as Herceptin, and the development of additional drugs, should Herceptin stop working, has given patients with this type of cancer much more hope for a full recovery.

Two of these new drugs for metastatic HER2+ cancer are “antibody drug conjugates” (T-DM1 and trastuzumab deruxtucan). Dr. Winer described them as Trojan Horses, as they can deliver the chemotherapy with which they’re paired directly into the cell, greatly decreasing side effects to the patient.

It’s so refreshing to hear the words “cancer” and “cure” used together in the same sentence. We are making serious progress now!

Perhaps most important, Dr. Winer actually used the word “cured” when talking about the outcomes for early stage HER2+ cancers, something that is truly remarkable. This is especially true for women with stage I cancers.

Many patients with stage II & III cancers receive the drugs prior to surgery, which can decrease the need for mastectomies and complete removal of the lymph nodes. In addition, pre-surgical treatment can guide the medical team in adjusting later therapies, based on how the tumor reacts to early drug administration.

Finally, Dr. Winer spoke of the stark disparities in cancer care, noting that black women are twice as likely to die from breast cancer as white women. Eliminating these disparities is his number one-rated area of importance for where to focus future efforts, something I strongly support.

TRIPLE NEGATIVE BREAST CANCER

Dr. Pusztai spoke of Triple Negative Breast Cancer (TNBC), and having lost several friends to this specific type of cancer, I was very interested in treatment advances that have been made. He described the differences beween TNBC and hormone positive breast cancers, noting that it’s likely that these two diseases orginated from completely different cell types, suggesting that these are different diseases and should be viewed as such.

It was exciting to learn that most of the patients with early stage TNBC disease are able to be cured (again, that beautiful word!). We now have both better treatment strategies and new drugs, and success rates are improving year by year. Dr. Pusztai emphasized the benefits of completing chemotherapy prior to surgery, going against our strong impulse to “get the cancer out” first. With the drug-first strategy, medical teams can adjust the post-operative treatments as needed.

The thing that was so amazing to me was that the recurrence-free rate of survival was 85-90% with these “modern regimens” for early stage disease. That’s impressive!

Next on the horizon is fine-tuning the right balance of drugs for patients, given that chemotherapies are still toxic.

There’s still a lot to be done, but all of this makes me feel so hopeful for a future in which a cancer diagnosis is something that we don’t have to fear.

Dr. Pusztai stated that he felt we already have the drugs with which to cure “at least some” of the metastatic TNBC patients, especially for those who are diagnosed at stage IV (rather than having earlier-stage disease that was treated and later metastasized). The idea is to utilize existing drugs but apply them using the new treatment strategies that have been developed. However, Dr. Pusztai stressed that new drugs are also being developed.

Q&As

There were a range of excellent questions that began at about the 45-minute mark, but as mentioned above, I enjoyed hearing the admissions by the doctors that they considered quality of life to be a very important factor in whether or not to continue medications, and they acknowledged that it is the patient who should have the control to balance their risks against their treatment options. Other questions included recurrence in hormone-positive cancers, development of drug resistance, genetic testing, continuation of care (“risk-stratified follow-up care”) and second opinions.

Dr. Winer commented that within a decade he felt we will have all the treatment we need to prevent and cure breast cancer in most patients, so again, he stressed that the focus must turn to making that treatment available to everyone, regardless of who they are.

LAST BUT NOT LEAST…

Dr. Winer admitted that many doctors, in treating patients, end up “taking over people’s lives and medicalizing their lives”. His approach, therefore, is “to try to provide therapy without making someone either unhappy or feeling like they are attached with a leash to their doctor’s office.” While there was some discussion related to this, I appreciated that doctors are actually thinking about this and want to allow patients to “live their lives”.

Finally, I was amused by the doctors’ admissions that even they found the drug names to be unpronounceable. It’s true that in my own treatment, I usually stuck to the easiest name to pronounce…I can’t imagine having to use those names on a daily basis!

I hope you found this helpful!

Finally, This Is My Real 5-Year Anniversary

I was going to write about something else for this week’s post until I realized that I had another five-year breast cancer anniversary to share: the end of my radiation treatment.

It had run for six weeks, five days a week — going to the cancer center became a daily habit. But on October 23, 2017, I rang the gong signifying the end of treatment, said my good-byes to the radiation oncology staff and left them with baked goodies.

Cancer treatment felt like a never-ending vortex of scary experiences…but it did finally end.

With 2022 being five years since my cancer diagnosis, I’ve had a number of anniversaries to share this year. What makes Oct. 23 significant is that it marked the end of all the “tough stuff” that people scare you with about cancer. By that date, I’d put the diagnosis, surgery, chemo and then radiation behind me.

Because 2017 had been a miserable year, when radiation was done I thought I could finally take a deep breath. I’d waited for this point in my treatment for a long time and decided that I would lose myself in the spirit of the holiday season.

The problem was, you never really get rid of all your concerns. You release some, but others show up to take their place. I finished radiation…but wait, there’s more! Now I was going on tamoxifen and that brought a whole new set of issues, and yes, fears, with it.

So I spent Christmas season doing my best to enjoy myself but the holidays passed by and left me feeling a little empty. I’d expected a lot out of them and they didn’t deliver.

I had wanted to be free of all my worries but that’s not how cancer works. In fact, that’s not how life works either. It took me five years to figure out that I couldn’t get what I wanted, but what I could make of it was beautiful in its own way.

Admittedly, it was a tall order. After cancer, I tought the world would shine with joy, but that wasn’t realistic. Cancer isn’t the kind of disease you say to, “done!”, brush your hands off and walk out the door. It tags along behind you, if not as the disease, then as its shadow.

Fast forward five years to now…ok, ok, I know what I got wrong back then.

I had felt like life owed me something amazing because it had put me through cancer. I thought I deserved a post-cancer life that was perfect. Of course, it wasn’t. And it still isn’t.

So if there’s something to celebrate, it’s that I learned a few things over the past five years.

This holiday season I’m not going to be expecting things to wow me. But I am going to be enjoying the fact that I am still physically active and working the same university job, expanding my horizons as a new yoga teacher and finding fun ways to spend my time. And mostly, that I have moved past the feeling of anger that I felt about cancer and found some gratitude to fill its space.

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I know I keep going on and on about how much better life is when you’re not carrying the burden of anger, but honestly, if I’d known that acceptance would lighten me up this much, I would have done it sooner!

Remember: You’re in the Driver’s Seat

Since we’re halfway through October – Breast Cancer Awareness Month – this is a good opportunity to remind everyone who’s had a cancer diagnosis that you’re still in control.

That might be very different from what you’re feeling. The whole thing with cancer is the sense that your life is out of control. Even your most faithful ally, your body, seems to be out to get you, growing a tumor behind your back.

Does it feel like someone else is controlling everything in your life?

That’s to say nothing of how your weekly schedule gets highjacked with oncological appointments, radiation treatments and days recovering from chemo. Then there’s the onslaught of new medical terms, the many pills that you’re supposed to take, even the practically unpronounceable chemotherapy drug names (what kind of a suffix is “-ib”???).

If anything, this might feel like the most out-of-control time of your life. When you’re slapped with a difficult treatment plan, you want it all to stop, but your oncologist tells you, “we won’t let you skip an infusion or stop taking your medication.”

That sense of being forced to do something (especially when it’s unpleasant) can open the floodgates to a deluge of anxiety on top of the fear and frustration that you might already feel about your cancer treatment. No one wants to feel like they have no say in a matter that affects them so deeply and personally.

This life is yours…and so are decisions about your cancer treatment.

But remember this: you always have a choice. Even though your medical team might not be phrasing it that way, you are still in control.

Perhaps this tiny acknowledgement may relax some of that perceived pressure and actually make it easier to continue. Your cancer treatment choices remain yours to make, so allow that realization to help you to step back, get perspective and weigh your options. When you demand space for yourself, you have room to think and it’s easier to act in your own best interest.

So, breathe. You’re still calling all the shots.

And, hey, medical team: maybe stop being so pushy and remind those cancer patients that they get to make the decisions about their treatment and their lives. It would go a long way towards helping your patients feel better about their treatment plans, like they’re part of the team instead of a prisoner of their situation.

It’s Time to Ease Off Ourselves

You’ve probably heard this phrase in a commercial somewhere: “If I can do it, so can you!” It’s meant to make difficult goals seem attainable. 

Some people may find this very motivating. And it certainly can be. Sometimes all we need is a little spark of hope to push us into achieving great things.

But it can also be used as an instrument to shame people into thinking that they’re not trying hard enough. That there’s something wrong with them. 

Just because you’re not getting the results that someone else did does not mean that you lack a good work ethic.

From a marketing standpoint, the idea is that you push responsibility off the item or program or whatever it is you’re selling, and onto the person buying into it. Because obviously, there’s “proof” that it works. I mean, it worked for someone. So if you’re not getting the same results, it’s an issue that you have.

I’ve also seen this used with cancer patients. An exceptional individual who has defied the odds and still accomplished so much under negative circumstances is held up as an example of what is possible. They’re called an inspiration. 

And it’s true, what they did was possible. For them. But we know very little about what else was going on in their lives to support their endeavors.

It’s admirable that these people are able to achieve what they have, but it’s unreasonable to expect that from everyone. And sometimes obstacles that no one else can see (emotional pain, underlying fears, mental illnesses) may hinder us, and the best that we can do is get through the day. Or sometimes, just manage to crawl out of bed.

We may know this and yet still hold ourselves to those standards, and as a result, reap disappointment.

Why am I bringing this up now?

Maybe it wasn’t that you didn’t try hard enough. Maybe it’s because the goal was not the right goal for you.

Because as a cancer survivor, I’ve expected things of myself that I simply cannot do anymore and then became frustrated with my inability to fulfill my unrealistic expectations.

And hated myself for it.

So this is a little reminder to consider what is right for you. Definitely, set goals and seek higher heights! But make sure they are your goals and they fit your life and abilities. That they are meaningful for you. This may require you to adjust your expectations in a way that demonstrates respect for yourself.

Because if someone is trying to amaze you with whatever they’ve done that they’re trying to convince you to do, consider that they might be getting far more out of your willingness to try to live up to their standards than you’ll get out if it yourself.

Maybe Being Stinky Is Not So Bad?

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.

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.