Health – Frantic Shanti

Breast Cancer: Do You Know Your Risks?

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Since we’re creeping up on October, commonly known here as the very pink Breast Cancer Awareness Month, I thought it might be a good time to post the most common risk factors for breast cancer…and then explain the problem with focusing on them.

For reference, I used the risk factor list posted on the U.S. Centers for Disease Control and Prevention (CDC) website. The CDC’s list focuses on women, as they are the ones at greatest risk of developing breast cancer; a shocking 1 in 8 women (~12%) will develop breast cancer at some point in their lives.

But on to the list. The CDC divides breast cancer risk factors into two categories: risk factors that you cannot change and risk factors that you can change.

The ones that you cannot change are the following:

Age – The older you are, the greater the risk, with the majority of cases occuring in women aged 50 and above. Last I checked aging was still a thing, so we’re all heading in this direction.

Genes – BRCA1 and BRCA2 mutations put you at significantly greater risk for breast and ovarian cancer. This is one family heirloom that you’re better off not inheriting.

Age at first menstruation and menopause – Starting periods before age 12 and menopause after age 55 exposes you to higher levels of circulating female hormones for a longer time. The longer you steep in hormones, the more chance of developing the cancer. This is a little unfair, I think, because estrogen also helps maintain muscle mass, bone density and skin elasticity which are all good things, but that’s how it goes.

Breast density – The denser the breast tissue, the higher the risk. Denser tissue also potentially makes it more difficult to detect tumors. Dense breast tissue is less fatty and more fibrous and glandular…and more likely to occur in women with lower bodyfat, which is ironic considering it’s also better to leaner (see below).

Find out your family history of cancer and explore your genes.
(Photo by Antonino Visalli on Unsplash)

Personal and family histories of cancer and other breast diseases – Having had previous breast cancer yourself or in a close family member (including ovarian cancer) may raise your risk. This is a great reason to make health a family affair and encourage everyone around you to do what they can to reduce their risks.

Early exposure to radiation therapy – Having had radiation treatments to the chest prior to age 30 may raise your risk of developing a tumor later on. This is a double-whammy: survive one cancer (like lymphoma) by going through treatment…and get smacked with breast cancer.

Diethylstilbestrol (DES) – If you were given DES (to reduce chances of miscarriage; no longer prescribed) or your mother took this drug when pregnant with you, it may have increased your breast cancer risk. Again, proof that life isn’t fair.

The risk factors that you have some control over:

Physical activity – Being sedentary is associated with higher risk. If you ever needed a wake-up call to get moving, this is it (and while you’re at it, have your family members join you).

Postmenopausal overweight or obesity – Being an older woman with a higher bodyfat percentage may increase your risk, so menopause is a great time to reevaluate your diet and consider why you’re eating what you’re eating—is it just out of habit? Boredom? Depression?

Hormone replacement therapy – Taking hormones post menopause for more than five years may increase the chances of developing breast cancer (see “Age at first menstruation and menopause” above). So unfortunately, hormone replacement treatment to help with menopausal symptoms may end up working against you.

Pregnancy history – Never having a full-term pregnancy, getting pregnant after age 30 or never breastfeeding may all affect your risk. To be fair, these can be more difficult to control and no one should ever feel guilty about any of them.

Rethink your drink.
(Photo by Bermix Studio on Unsplash)

Alcohol – Drinking alcohol increases your risk of developing breast cancer. If you are using alcohol as a socially-accepted means of self-medication, consider quitting and using money you’d otherwise spend on drinks to find yourself a good therapist.

There are of course other, perhaps less well-established risk factors, but the above give an idea of the wide variety of different factors involved.

Okay, so what if you can say that you’re in the clear with most of these factors? I certainly did. Based on my lifestyle, I figured that breast cancer was something that I’d never have to worry about.

And I had reason to think this way. According to the National Cancer Institute’s risk calculator, at the time of my diagnosis, I had a 1.3% chance of developing breast cancer within the next five years. That is a very low percentage! And yet, I developed a tumor.

Does that mean the calculator’s answer isn’t meaningful or that risk factors don’t matter? Not at all. It means that your risk percentage is only that, your calculated risk. Everyone would be well-served to live as healthy a life as they can, keeping in mind that having a number of risk factors doesn’t definitively mean that you will get breast cancer.

At the same time, no one should assume that a low risk means you won’t get cancer. It’s still very important to get screened regularly and see your doctor about any lumps that you find, because while you might not be able to prevent breast cancer despite your best efforts, catching your tumor at an early stage provides you with the greastest chances for a positive outcome.

Another Oncology Visit and “Not Being Good Enough”

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“I see pharmacological interventions in your future” is a paraphrasing of what my oncologist told me at my last doctor’s visit.

So let me back up a bit. I had my “eight-years-since-finishing-chemo” appointment with my oncologist last week. Things went the way they’ve been going for a while. He was very pleased with how things have been going and that made me feel very positive.

Certainly, I have my share of stressors churning at the moment, but most of them are not health-related. Most.

When my oncologist reviewed my bone density reports, however, he made the same prediction that he has during my previous two visits with him (see his quote above). The issue is that my bone scan in 2019 showed osteopenia, which I have to say is pretty weird given my lifestyle, which includes a lot of strength training. We both thought that perhaps it was an issue with the way the numbers were calculated.

Unfortunately, my 2024 bone scan showed a significant loss of bone compared to 2019. Enough to really concern my oncologist and befuddle us both.

So despite my living the lifestyle that medical guidelines say I’m “supposed to” live in order to stay healthy and strong, it’s still not good enough.

Tried as hard as you could? Well, too bad, try harder.
(Photo by Mads Schmidt Rasmussen on Unsplash)

This harkens back to what I experienced after being diagnosed with breast cancer. It seemed like I had done everything I could to lessen my chances of getting cancer, including things that should have been protective, but there I was, a breast cancer patient, and a young one at that (which, I later learned, what one of the reasons the risk factors didn’t necessarily apply to me, but I didn’t know that at the time).

It drove my perfectionistic mind haywire.

It brought on feelings of helplessness and even despair.

The only thing that gave me a bit of a lift was learning to meditate. Meditation imparted a sense that I had a teensy bit of control, if not on the situation, at least in the way that I reacted to it.

I got through that period of my life, brushed myself off and went on. And for a while, I was feeling blessed.

But cancer treatments have long-term effects. And the repercussions of being pushed through menopause and being on endocrine therapy eventually caught up to me. Physical movements that used to be easy started to hurt. I lost muscle mass…and apparently, I lost bone too. I felt like I was treading water with a weight tied around me.

Never good enough.

So I am bearing down and reworking my diet and exercise program even more. And to be honest, this is also an opportunity to shed some of my perfectionistic tendencies. While I want to feel like I am doing everything I can to help stop my bone loss and avoid taking medication for it, I need to learn to give myself grace. Sometimes even doing everything “right” will not be 100% successful, and I have to be okay with that.

All I Want for Christmas is No More Auras

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This was supposed to be a post for USA residents about how to find some harmony during the Thanksgiving holiday amidst the tensions brought by relatives with strongly differing views of the world. Such disagreements are always a possibility when families get together, but likely even worse this year.

But, no. Instead, I’m sitting here wearing sunglasses in a darkened room as I plink out this post.

Remember those shimmering scythe-shaped mosaics (auras) that I wrote about intruding on my vision some weeks ago? The ones that are associated with ocular migraines, but in my case minus any headache? Well, they’re still happening and with greater frequency.

Depending on which of my healthcare professionals you talk to, they either want to (1) wait and see how things progress or (2) shove me into an MRI tube ASAP.

Trying to keep my sense of humor…

And me? I really want to not be dealing with this issue. After seven years of putting a lot of space between my cancer diagnosis and the present moment, I am getting stressed by the possibility of this being something quite serious. And all I wanted was to enjoy the upcoming holiday season.

But I’m getting ahead of myself. Here are the details: I’ve now had seven of these episodes in about two months—I’m not even sure when the very first one was. After the last one (which was the second of two last week), I left a message with my ophthalmologist.

However, it was my oncologist who happened to call a few hours later, completely coincidentally, to give me unrelated scan results.

So, since I had him on the line, I told him about the auras. He sounded sad. And you know what? You never want your oncologist to sound sad, especially when they’re usually so good at being neutral when delivering news.

And then my ophthalmologist called back late that afternoon, urging me to see my primary care doctor as soon as possible and also schedule an appointment with her for the next day.

Next day, I snag a morning appointment with my primary care provider, explain the situation and the fact that I have no other symptoms other than the auras. Her take: this is very weird, yes…but it’s a hard sell to get this to qualify for an MRI at this time, even with the frequency. With my consent, she wanted to wait for a little bit and see whether the auras continued.

Or, I guess, until my head exploded or something.

Find a happy place, find a happy place, find a happy place…
(Photo by serjan midili on Unsplash)

When I saw my ophthalmologist that afternoon, she was extremely concerned and incredulous that an MRI wasn’t the first course of action. I could tell that she felt waiting was a bad idea.

But ultimately, she acquiesed to the notion that we’ll wait, although she’s sending a synopsis of her findings to my primary. She instructed me to take excruciatingly detailed notes the next time one of these auras occurs

And if you’re still reading this far down and are convinced that my goose is cooked, maybe it isn’t. Sure this whole experience is stressing me out. But there are far too many confounding variables present to resign myself to the fact that I’ll be getting my head shaved again soon…variables which I might be writing about in a future post…

…or I’ll be talking about my ride in the MRI tube and subsquent diagnosis.

But for now, I’m going to rest my eyes in a darkened room and think of silky fur on a contentedly purring kitten.

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For everyone in the USA, have a wonderful Thankgiving with your lovely families this Thursday…and let’s all try to keep it civil.

I Saw My Oncologist…and Left Ridiculously Happy

^{(Title image: Photo by Nick Fewings on Unsplash)}

Yep, this is another installment of “I had another oncologist appointment today”. This time I’m marking seven years since completing my chemo treatment, which I can assure you at the time was a very happy event…

…marred only by that little nail infection a few weeks later. But don’t go there unless you have a strong stomach.

Regardless, I had a great meeting with my oncologist. The concern now is about whether I’m experiencing anything cancer-related, either long-term side effects or—perish the thought—a recurrence. Today the answer was neither.

We talked about the recent death of my father…and that’s pretty much the way the appointment went–catching up on the last six months. Naturally, I forgot to tell him about a bunch of the other concerns I had, little weird things in my body. But really, they’re not unusual given what I’ve gone through.

If there’s one thing I’ve learned, it’s that I need to slow down when interpreting body sensations as health problems. Usually they’re not. (Even though once they were cancer.)
(Photo by LOGAN WEAVER | @LGNWVR on Unsplash)

We did, however, discuss how it takes a little while to get used to all those sensations in your body. After cancer, I was on high alert. My medical team was asking detailed questions about what I was feeling, and as a result, I was laser-focused on every twitch and twinge…and maybe some that I just imagined. At one point, I was sent for a brain MRI because of what I feared were serious cognitive issues. But in reality it was anxiety, not a tumor.

Seven years out, however, you kinda get expect all those funny sensations and don’t interpret them as being dangerous anymore. Even the heart palpitations that I would get from time to time…yeah, I still get those, maybe once a week, maybe a couple of times a month. But they only last a handful of seconds and I no longer think that my heart is failing (especially not when I can turn around and do a HIIT workout). I haven’t been back to the cardiologist and my oncologist agrees that it’s not necessary.

He asked if I wanted to come back in six months. Sure, I like being back in the Cancer Center as *NOT* a cancer patient. It’s nice being there and remembering doing jigsaw puzzles in the radiation oncology waiting room, or even feeling well-taken-care of after my treatments were done. There ARE positive memories in a place that you’d think would only be negative.

That can change very quickly, of course. But for the time being, I’m feeling happy.

Kidney Stones: Errr, Maybe Not?

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So my health has taken an interesting turn.

About a week ago, I went to see a nurse practitioner (NP) for an interesting combination of symptoms: nausea and middle back pain. After listening to my complaints, she determined that the cause was most likely kidney stones.

So…I’m not the typical kidney stone sufferer…but I wasn’t the typical breast cancer getter either, so I accepted her diagnosis while we awaited lab confirmation of whether there was blood in my urine (TMI, sorry).

And then I proceeded to waste an entire weekend on the Internet, driving myself bonkers about what foods contained oxalates (a common kidney stone culprit) and how to combine foods that did with calcium, but not too much calcium.

I was treading in the Wild West of the Internet and I soon learned that kidneys are big business and everyone not only has an opinion, but is also selling something.

Kidneys = $$$ and clear and concise info was harder to find than I anticipated. More stress!
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At the same time, except for one relatively bad night with a lot of pain, most of my symptoms remained mild-ish. Definitely not “hurts more than childbirth” level.

However, as a result of this, I was afraid to eat, which seemed to increase the pain and I realized that it was actually kinda sorta in my stomach?

Four days after submitting the urine sample, my NP called with the results: no blood in the urine.

That made the “kidney stones” story more difficult to believe. So after more discussions with her, she settled on the possibility that I might just be experiencing particularly bad heartburn and prescribed omeprazole to reduce the levels of acid my stomach produces.

This actually made a lot of sense to me. I am one of those “stress non-eaters”: in difficult situations I lose my appetite quickly, go for longer periods without eating and tend to lose weight. That leaves a lot of time for my stomach to sit empty.

But this also brings up another point that I find personally interesting. I have consistently been doing better with handling general stress and anxious episodes. I now have a plan for stress that includes understanding my reactions and using mindfulness, meditation and exercise. As a result, I experience far fewer episodes of runaway anxiety.

Stomach, stress…it all feels like fire.
(Photo by Yaoqi on Unsplash)

However, I am not able to control everything that happens in my body. I might be able to soften my response to stress and anxiety, but over the long term my body may still show signs of wear and tear from the pressures that I face.

This may also mean that while I’m doing great with keeping my stress levels lower, I might not be doing as great as I think I am. If this is truly “heartburn” or a little ulcer or something, it’s a reminder that managing stress is a constant process that requires vigilance.

Oh, and there’s also the oxalate thing, which my NP said not to stress over since it’s probably not a kidney stone. Which is good. Except now I’ve bought a bunch of low-oxalate foods, a number of which are the ones that I learned I should avoid for stomach issues.

Health is becoming a nonstop game of whack-a-mole.

Kidney Stones: Like I Needed That, Too

File this under, “lucky me”.

Well, I started experiencing nausea with no discernable cause last week. Wasn’t too bad and I assumed it was, I dunno, just my body being weird. Or maybe the pack of raw sugar snap peas that I had eaten the day before.

But the next day I woke up with middle back pain. I assumed that it was due to a new strength training workout that is known for evoking muscle soreness, and I figured that I’d just overdone it.

The nausea got worse, the backpain didn’t abate.

After a few days of this I decided to make an appoinment to get it checked out. This was partly because Dr. Google suggested that this could be an issue with my gall bladder or a kidney stone. I waved the gall bladder possibility off because the symptoms didn’t seem to match…but the kidney stones? Kind of ridiculous, I thought. I regularly drank a lot of water, ate limited processed food, was a vegetarian…you get the gist. I didn’t think I had the most common risk factors for it.

Then again, I didn’t have the most common risk factors for breast cancer either.

My nurse practitioner listened to my complaints and pronounced the most likely diagnosis: kidney stones.

I just don’t get it.

Why do these things happen?

This…is not gonna be fun.
(Photo by Sasun Bughdaryan on Unsplash)

After trying to live an exemplary life diet and exercise-wise, breastfeeding my kids and whatnot, seven years ago I got cancer. That’s one of the most terrifying diagnoses you can get.

I did not enjoy treatment. But eventually I got through it and learned to deal with the uncertainties that cancer brings.

Now, I may have a kidney stone. A “more painful than childbirth” kidney stone, which people that I’ve told like to point out is *ahem* very painful. Exceptionally painful. Severely painful. Hello, these reminders don’t help.

On the bright side, this probably won’t kill me. I’ll only wish that I were dead.

I was already thinking about how ridiculously unfortunate it was that the stressors I’m currently dealing with were taking place all at once (that’s another story that I won’t bore you with). I was not asking for yet another one.

And it gets even worse: I was given the opportunity to teach yoga to cancer survivors in about a month, something that I was so excited about! It was such an amazing chance to do exactly the thing for which I become a registered yoga teacher.

By the way, the average time for a kidney stone to pass is, you guessed it, a month. (To be fair, I’ve also heard anywhere from 1 to 6 weeks, so it kind of depends whom you ask). The timing just sucks.

I learned that the main protein sources for vegetarians are very high in oxalates, which are some of the most likely culprits in the formation of kidney stones. As a matter of fact, so much healthy food (dark leafy greens, for example) is actually high in oxalates, with spinach being number one. Who was eating spinach almost daily? Right here, me!

In the meantime, conflicting information on the internet about what I should be eating is stressful because I feel like I’m making things worse every time I put food in my mouth. My main staples are coming up as no-nos.

So what am I going to do? Try not to catastrophize. My mind is my worst enemy and comes up with all kinds of unpleasant possibilities as I wait for urine test results and probably a CT scan.

I’m going to ride this out the best that I can. That means keep practice teaching for my yoga class and consider this another test of how well I can prevent my scary thoughts from dragging me down a frightening rabbit hole.

Update when I know more.

Things I Wish I’d Known About Breast Cancer, Part 2

This post continues what I started in the last post…a few things about breast cancer that I wasn’t aware of at the time of my diagnosis. Knowing the following would have made things a little less stressful:

1. Lumpectomy is a relatively uncomplicated surgery. I wish someone had explained this to me because I was a total wreck going into surgery (which happened to be the only surgery that I had ever had up to that point, making everything 10 times worse). Although I had decided against a full mastectomy, I was still so afraid of what a lumpectomy would entail, what I’d look like and how long it would take me to recover from losing a chunk of flesh.

The reality was…I was back at work the next week. No drainage tubes, no need for heavy analgesics — just a couple of ibuprofin the night after surgery because skipping coffee that morning resulted in a headache, but that was it. It was even hard to tell that I’d had my lump excised. Wish I could go back to my earlier self and tell her not to worry.

Stethoscopes are emotionless. Oncologists can seem to be too, but that’s by design.

2. Doctors are not in a hurry to give you good news. I think there’s a general feeling among medical professionals that there’s so much that can go poorly during cancer treatment that your doc isn’t going to go out of their way to pump you full of optimism. They probably practice keeping an emotionless face as they deliver all sorts of news, both good and bad. As a patient, however, I watched every flicker on my oncologist’s face for an indication of how things were “really” going. I feared that there was something he wasn’t telling me.

It wasn’t until perhaps a year or so later when I was expressing my fears to him about possible abnormalities inside my body that he uttered the phrase, “but you have your health”…and I was taken aback because I had never heard him sound so positive. It was almost a shock to hear him confirm that I was actually considered healthy.

3. Don’t expect things to be the same as before. Accepting that part of your life has changed will make it much easier to go on. This took me a while to appreciate because I was expecting to get back to doing and feeling everything the same as before my diagnosis.

But chemo (and eventually, age) pushed me through menopause, and I had to come to grips with, say, a high-intensity interval workout requiring more recovery time and that I had trouble remembering people’s names. Once I got to that point of acceptance, life after cancer treatment became easier, although it did take a number of years to get there.

4. Hair takes a while to grow back in. The reason I created posts with photographs that illustrated the cancer journey that my hair went through (here and here) was because I could not find good photos on the internet documenting the process. I did see images of a woman a few weeks after stopping chemo with little stubs already visible, but that was not my experience and it made my anxiety over my slow regrowth even worse.

Walking around with no hair was getting old and I was getting more desperate by the day to see evidence of sprouts!

If you’ve ever googled your chemo drug name + “hair loss”, you understand the fear: the first search result is usually a law office gathering info on behalf of cancer patients whose hair never grew back!

It took a number of months before my folicles woke up and actually started growing. I remember the moment that I finally saw growth on the front of my head and it was as if the heavens had opened up and divine light poured out onto me. Seriously. I would have avoided a lot of stress if someone had just told me that it’s gonna be a while.

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Ok, ok, to be fair, my oncologist did urge patience with the regrowth but I was a jumbled mess of nerves and was feeling overwhelmed. All the internet propaganda about both (1) other women having much faster regrowth, or (2) other women never getting their hair back terrified me. Note to self: when feeling desperate, stay off the internet!

Perspective: The Broom that Sweeps the Mind

Last week, I had a good reminder about the importance of maintaining perspective.

It had been a stressful few days at work. At the height of it I found myself in a problematic situation, trying to “fix” an issue that wasn’t my responsibility by sending a quick email. I would have done better to pause, but I was in “go-go-go” mode, driven by anxiety that the situation was causing.

Afterwards, I found myself obsessing about what had happened and how I had reacted. So even though I had initially felt that my email response was the best course of action, by evening I was convinced that it was the worst. This opened the door to allow in unrelated doubts about myself. That frustration carried into my nightly meditation, and ultimately, into fitful dreams.

In a few seconds, a perspective shift changes your entire view of things.

The next morning, I felt marginally better. But it wasn’t until I checked my text messages that my perspective shifted. I received photos of my father, leg in a cast, at the local hospital’s emergency room. Reason? Cracked tibia bone and deep vein thrombosis.

In an eyeblink, I forgot about what had happened with work. I needed to get more information about my father’s predicament.

As news of exactly what had happened filtered down to me (it was a much more controlled situation than I had initially understood it to be), I went into the office with a different mindset. The work stress that had been top-of-mind and in-my-face was now way over there in the back of the room.

FYI, my father is fine and the trip to the ER was actually a follow up from the previous day’s visit to his doctor where they discovered the fracture and the blood clot. The doc had encouraged the ER trip to get quicker access to an orthopedist. My dad is in good spirits and my mother (a former nurse) has been tasked with administering the clot-dissolving injections.

But the shift in perspective that morning reminded me so much of a similar shift several years ago: prior to my cancer diagnosis I had been experiencing a lot of anxiety at work…but once I learned that the lump in my breast was cancer, everything else fell away. It was as if the roar of work stress suddenly became muffled and all I heard was my beating heart, my health, the important stuff.

When I had cancer, the things that used to bother me, stopped. I knew then what was really important.

I distinctly remember that as I was going through my cancer treatments, in all the concern about what was happening in my body, I experienced the least amount of anxiety about anything going on at work that I’d ever had at that job. It felt like I could handle anything that they threw at me.

Perspective. That’s what I had as I sat in the infusion room. And that’s what I regained last week.

How curious that the shift in perspective was so simple to achieve. All I needed was to remember what was really and truly important and everything changed within a few seconds.

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“Simple” is not necessarily “easy”. We have so many things coming at us in the course of the day and we try to triage them as quickly as we can. It’s expected that we will make “little mistakes” and give more weight to the problem right in front of us–those things that are immediate. But with practice, we can realize that most of those are transient and the important stuff is what deserves our deepest attention and appreciation.

And even the “important stuff” needs to be swept out once in a while.

Three Pillars of Fitness: Consistency, Progression and Balance

Although this is a blog about cancer and mindfulness, I hardly think there is any lifestyle habit as effective as exercise at helping survive cancer. And what better time to discuss this than the start of a hopeful new year?

I’ve been certified as a personal trainer by the American College of Sports Medicine (ACSM) for well over a decade, and although I haven’t actively taken on clients, I’ve had enough time to develop my own fitness philosophy. I must stress, this is a conceptual post and not designed to guide you to specific exercises (although I mention some modalities as examples). However, if you’ve had trouble getting your head around how to maintain an active lifestyle, these ideas may help.

In my experience, there are three critical aspects to a successful exercise program: (1) consistency, (2) progression and (3) balance.

CONSISTENCY

This is the most important concept of my three and worth spending the most time on.

Consistency is the concept that seems to be most difficult for people, and it’s usually the “make-or-break” aspect of fitness. It’s quite simple to get motivated to start a new program, whether it be signing up for classes, planning out home workouts or simply deciding to go for a brisk walk every day.

The hard part is sticking with it. But I can promise you, that’s where the magic is. Be realistic about how much time you have to devote on a daily basis and what your exercise will consist of. This should not be something far out of your realm of experience or else it will be too difficult to maintain. Make it familiar.

When starting out, pick something you enjoy doing and it’ll be easier to keep doing it!

For example, if you do not already have a consistent history with a piece of exercise equipment (say, treadmill), do not purchase one under the assumption that the high price tag will surely motivate you to use it. It will not. The greatest workout you’ll get with it is carrying it to the basement or attic after you can no longer stand the guilt of watching it gather dust.

If you can’t maintain your workouts, you will have to go through the “beginner” phase every time you summon the wherewithal to restart again.

That also means going through “beginner soreness”. Honestly, there’s little pleasure in a Groundhog Day-like experience of not being able to get past the little aches and pains you might feel after getting your body into motion again. Don’t do this to yourself.

How to avoid it? Look at exercise as a lifelong habit, not something you do just to “get in shape” for a specific event like a wedding or reunion. Take smaller bites of exercise, something very doable that you won’t dread, especially if you have negative associations with workouts. Set goals like “train 5 days a week” and plan them out, not “lose 15 pounds” or even worse “look better” (what’s that?). It’s more motivating being able to tick off a specific, finite goal than never reaching one that’s vague, arbitrary and even judgemental.

And DO consider it “training”. You are training for living the rest of your life with more ease, maintaining your flexibility, balance, strength and endurance just that much longer. As in the tale of the tortoise and the hare, starting something that seems “not vigorous enough” but that you can see yourself doing, say, every day, in a year will put you miles ahead of someone who started an ambitious and complicated exercise program and burned out in a matter of weeks.

The fitness industry is banking on the fact that people will start exercising and then give up, only to start again later. And eventually give up again.

Look at it this way: the trillion-dollar exercise industry is betting on you giving up, and so it always comes up with a new shiny object to tempt you with. Often the program is unsustainable and the promised results are unrealistic. You don’t need that. You need consistency.

Again, decide what you can do and do it regularly. Realize there will be days when it won’t be possible to get it done. That’s okay – no guilt, no shame. But then get right back to it as soon as you can. Think of every workout as something positive and precious that provides you with health benefits that no one else will be able to take away. Each day you exercise is one more step towards establishing a habit that will lead to a lifetime of fitness.

IMPORTANT: Put up a high-visibility calendar where you can mark off your workouts and easily see how consistent you are.

But what if it gets TOO easy? That’s when the next pillar comes in…

PROGRESSION

Once you’ve established an exercise habit, your body will eventually adapt to what you’re doing. This is a very good thing. It also means that it’s time to change things up a bit, always giving yourself permission to dial back down to what you’d been doing previously if you have a harder time getting going on any given day.

Is your walking route getting too easy? Make a detour to a set of stairs and get your heart rate up!

The trick is to maintain consistency while also challenging yourself. For example, if you were doing a walking program, incorporate bodyweight exercises (squats, modified push-ups) that you can do along the way. Climb more hills. Pick up the pace.

If you want to get a PhD, you don’t keep taking freshman-level classes. Challenge is where growth happens. We get an unmistakable sense of satisfaction putting in the work and seeing results.

This is also where your self-confidence blossoms. And that’s exactly the bouyed spirit that keeps you going.

Don’t ramp everything up at once. Add a little at a time, but definitely make it count. Be realistic about whether or not you’re challenging yourself: if you need to push it even more and can do so safely, go for it. If you honestly try but can’t do as much as you expected, halve the amount and try again. Don’t beat yourself up. You will get there. But don’t short-change yourself either.

Keep writing it down! When you’re ramping up your fitness program it’s important to keep track of your progress.

Most importantly, unlike high school PhysEd class, you’re in charge. That also means you’re responsible for your own progress. Some workouts will be better than others, but always remember, doing anything is STILL better than binge-watching Netflix with a bowl of chips on your lap. Congratulate yourself for making the decision to exercise!

Hey, why not watch Netflix while marching in place? It still counts so write it down!

So let’s assume that you’re being consistent and gradually increasing the duration/intensity of your workout. That’s perfect, but there’s one more pillar to consider…

BALANCE

In this case, I don’t mean balance as in being able to hold tree pose throughout your entire lunchbreak. I mean are your workouts well-rounded? I’ve seen runners do little else but run. If this is you, incorporate some variety into your life. Your running will improve if you are also training for strength and flexibility.

Hey, your other shoulder needs massaging too!

Here’s a simple analogy for balancing out your workouts: imagine getting a massage regularly, but on only the left side of your body. That side will feel great, but you’re missing something. Your right side needs some love too. Eventually that imbalance will affect you negatively.

Exercise programs are best when they are a melange of endurance, conditioning, strength work and staying limber. It is extremely tempting, once you become adept at an exercise modality, to keep at it at the exclusion of everything else. After all, you’re an expert in it. But you’re also opening yourself up to injury and that’s something no one needs.

Treat your body to something new just to keep things interesting.

Take the time to explore different modalities. Often a type of exercise (say, yoga) can cover a number of bases, but you will still need to supplement with other exercises to stay truly well-rounded. Even strength training (which I consider critically important, btw) can have a cardio effect, but much will depend on how your workout is structured.

Do some research but don’t over think this. Just make sure that you are supporting all your body’s needs. Taking the runner’s example again, strength training will help you maintain muscle mass that you might lose from too much running, and it, along with flexibility and mobility work, will help prevent overuse injuries.

This doesn’t mean that you have to significantly increase the number of workouts you do, just that you have to be creative in what you add to your exercise session. The idea is to incorporate what else your body needs to keep it humming optimally. And then, write it down.

BOTTOM LINE

Bottom line when you’re just starting out? Move. Even if you don’t really know what exercise you “should” do, just find a way to move. Dance. Wave your arms over your head. Break up sedentary times as much as possible. If you sit for an hour, stand up and walk in place for three minutes, swinging your arms. Don’t be afraid to work up a sweat.

Then keep doing it.

When you establsh one healthy habit, it’s easier to incorporate others to support it.

Above all, make it pleasant, so that you look forward to exercise as a break from those things in our environment that keep us sedentary. The human body was meant to move. That is its natural state. Give it the opportunity to do what it’s supposed to do, then let it recouperate and nourish it with healthy food. The idea is to start now and keep going for the rest of your life.

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Being an avid exerciser enable me to recover from cancer treatment much more quickly. Up until my last couple of infusions, I was rowing and lifting weights within a week after each chemo (mine were spaced three weeks apart). In an out-of-control situation like cancer, exercise was one constant that made me feel like I still had a grip something, and that made the whole experience better.