Yoga – Frantic Shanti

“Not Going It Alone”: Complementary Cancer Therapies

With as much sophisticated research as has been done on cancer, it still remains a confounding disease and much of the treatment may seem to be, for lack of a better word, medieval.

So it shouldn’t seem surprising that cancer patients also reach out for less conventional therapy to help themselves through the treatment process.

First, a clarification of terms used in this post:

Acupuncture is utilized as a non-standard treatment (for those who can take more poking)

Conventional medicine: chemotherapy, radiation, surgery, immunotherapy, etc., prescribed by your medical team.
Complementary medicine: non-standard treatment used in conjunction with conventional treatment; also called Integrative Medicine.
Alternative medicine: non-standard treatment used instead of conventional treatment.

Therefore, generally speaking, what distinguishes complementary from alternative medicine is whether it’s used with standard medical treatment.

According to a study (Crudup et al., 2021) that was presented at the 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), 73% of breast cancer patient participants stated that they employed complementary therapies in their treatment. However, while oncologists were supportive of such therapies, they were not aware of the extent to which their patients utilized them and thought that only 43% of their patients did.

Patients get more benefit from spiritual practices than most oncologists realize

Furthermore, oncologists felt that counseling, support groups, exercise, etc. were the most effective non-standard therapies, in contrast to patients who found great benefit in meditation, mindfulness and spiritual practices. While two-thirds of both patients and oncologists felt that complementary medicine improved quality of life, a majority of patients also felt that it improved their outcomes.

Wayne Jonas, MD, a co-author of this study, says: “Cancer is a complex disease that affects every component of a patient’s life. While conventional medicine is effective for curing disease, it can fall short in helping patients heal. Patients are turning to these therapies to look for hope and to improve their quality of life and well-being after diagnosis… .”

What types of therapies do these include? The website “Cancer Health” provides examples of some complementary treatments (see here for an explanation of each):

Acupuncture
Aromatherapy
Art Therapy
Biofeedback
Cannabis
Herbal Therapies
Labyrinth Walking
Massage
Meditation
Music/Dance Therapy
Qigong
Spirituality
Tai Chi
Traditional Medicine (Ayurvedic, Chinese, etc.)
Vitamins and Supplements
Yoga

[This list is by no means exhaustive.]

I used a number of these complementary therapies myself and can attest to the important role they played in my recovery. As Dr. Jonas points out above, conventional treatments “can fall short in helping patients heal” [emphasis mine], whereas non-standard therapies seem to focus on that aspect.

I believe that these additional therapies, particularly more spiritual ones, are what give us hope throughout the cancer experience. Patients should be encouraged to seek out additional, complementary therapies to help themselves move through treatment, fully supported by their oncologists and ideally also guided by them.

Did you rely on complementary or alternative treatments to help you through your cancer journey?

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REFERENCES

Original Research

Abstract for presentation:

Crudup et al. (2021) Awareness, perceptions, and usage of whole person integrative oncology practices: Similarities and differences between breast cancer patients and oncologists. Presented at 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), https://meetings.asco.org/abstracts-presentations/200685

Published research article:

Crudup et al. (2021) Breast cancer survivorship and level of institutional involvement utilizing integrative oncology. J Clin Oncol, 39, no. 15_suppl. e18588,
https://www.doi.org/10.1200/JCO.2021.39.15_suppl.e18588

Synopses

The ASCO Post Staff (June 7, 2021; updated June 15, 2021) Use of integrative medicine by patients with breast cancer. ASCO Post, https://ascopost.com/news/june-2021/use-of-integrative-medicine-by-patients-with-breast-cancer/

Tien C (June 28, 2021) Oncologists Underestimate the Number of Breast Cancer Patients Who Use Complementary Medicine. Cancer Health, https://www.cancerhealth.com/article/oncologists-underestimate-number-breast-cancer-patients-use-complementary-medicine

Descriptions of complementary therapies

Living with Cancer: Complementary Therapies. Cancer Health, https://www.cancerhealth.com/basics/health-basics/complementary-therapies

Yogis, Find Your Own Balance

I am a newly minted registered yoga teacher (RYT-200), having passed my Yoga Teacher Trainer (YTT) final exam in mid-May 2022. When I tell people I’m a yoga teacher, they naturally assume that I am extremely flexible and have impeccable balance.

But, no.

Yes, yes, when I’m warmed up I can touch my toes with straight legs, even put my palms flat on the floor…but in yoga practice, I prefer to keep a slight bend in the knee in forward fold. My balance is a little wonkier and I’ve been known to wobble and trip my way around a corner if I’m moving quickly.

I enjoy a deep yogi squat because I’ve been practicing that pose since childhood, but neuropathy pain in my feet prevents me from holding my back heel up high in lunges. So my abilities are spotty.

The gift of yoga is that it is available to all.

When I took level 2 yoga classes, part of the prerequisite for my YTT, I would regularly lose my balance in some of the moves that the younger class participants easily nailed. It took more brain power and concentration to keep my body steady (possibly chemo brain played a part). I’m sure other students would have been surprised that I was in yoga teacher training.

I mean, WHY would I even consider becoming a yoga teacher?

Because I want people to know that yoga is for everyone. While I’ve ranted about this before here, going through YTT classes really underscored the fact that, at least in the United States, yoga practitioners tend to be very homogeneous: young, white, female, flexible, affluent.

Come as you are. Nothing special needed.

This is particularly disappointing because there are other populations that would benefit greatly from establishing a yoga practice and arguably might need it even more for their well-being. Slowly, yoga is being made available to “the rest of us”. But it’s going to take a while.

So I urge you, seek out yoga in parks and free classes at the Y. Explore YouTube for gentle beginner yoga videos so you can practice from home. You don’t need the burning sage, expensive yoga pants, organic cork blocks or trendiest mat. You just need to show up, follow along with the poses and breathe.

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To be fair, my balance and flexibility have improved significantly with regular yoga, and that’s my point: I didn’t need to be super flexible to begin. No one does. But if the message that yoga studios and fellow yogis are sending is that you already need to be able to strike a complicated advanced pose, think of all the people who won’t even consider starting.

And I have learned to seek out modifications for those yoga poses that throw me off center. The old self-conscious me would have thought that made me a failure. But I know better now.

Because I know I can do the most important pose very well: sit quietly and breathe.

Namaste ❤

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.

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.

Yoga Is For Every Body

As my interest in and personal practice of yoga has increased, I’ve noticed something peculiar about images of yoga. They send a message that you have to be young, slender and unnaturally flexible to be a “real” yoga practitioner. That seems daunting to anyone who doesn’t fit that mold.

I noticed something similar after I became certified as a personal trainer. I myself loved the feeling of strength and freedom I got from exercise; however, many people I spoke with were reluctant to go to a gym because they felt they needed to be in a certain physical condition before they even started. At the same time, they were daunted by the idea of striking out on their own. Even worse, in personal conversations with experienced exercisers and even other trainers, I found many would poke fun at those who were just starting out.

Come on, everyone has to start somewhere. An expert is just a beginner who stuck with it.

I thought yoga would be different, given the emphasis on one’s inner state. But I had to get over my apprehension about trying to fit an older creaky body into the unbelievable positions modeled by the yoga teachers I saw online. It was daunting. While I still felt strong, I seemed to lack that which yoga demanded. There were many poses that my old injuries and life-long inattention to flexibility would prevent me from doing.

I mean, google Flying Dragon pose and you’ll see why. Heck, it doesn’t even have to be as exotic as that. Go to Pinterest and search for yoga images – the results seem almost outrageous, with every yogini outdoing the one before them. Is that what we’re supposed to aspire to? I don’t see anyone even close to my age. Are they all in physical therapy? Or traction?

My spine doesn’t bend like that.

This is more my level: still challenging, but quite doable.

But this is yoga, right? There are quite enough poses that most everyone can learn and use to build a regular yoga practice, no matter what the images on the Internet suggest. More importantly, there are modifications for whatever your own body will allow. Can’t put your forehead on your knees in forward-fold? Then how about a ragdoll variation. Guess what, it’s still yoga.

That doesn’t mean that what those super-bendy instructors are doing isn’t impressive. But I view them much as I view someone free-climbing Yosemite’s El Capitan. With awe and admiration for their abilities. And then I delight myself by finally being able to touch my toes again, thanks to my yoga practice.

Regaining Control Through Mindful Living

As I mentioned in a previous post, I’ve really enjoyed the Coursera course, “Engineering Health: Introduction to Yoga and Physiology“, which I highly recommend. One of the recurring themes of the class that I’ve found particularly relevant is that of effecting incremental and meaningful epigenetic change through yoga and meditation.

The class lectures went through the physiological mechanisms by which this happens, and this information would be reason enough to incorporate mindfulness and breath-to-movement in one’s life. But for someone who’s experienced cancer, there’s something even more important: a sense of control.

For me, the most terrifying part of my cancer diagnosis was the lack of control over what was happening to me. First, my body had turned on me by cultivating a tumor, the ultimate goal of which was to take over my organs and kill me. Then, my doctors were giving me drugs that by design would kill certain parts of me, with the intention of taking out the tumor before it spread to really important parts of me (brain? liver? heart?).

My body was a battleground in the war between my rogue cells and modern medicine. I had to sit there and take collateral damage if I wanted a chance at survival.

Disclaimer: So I feel the need to stress here that we do not yet know how to reliably prevent the formation of cancerous tumors, but there are things that we can do to greatly lessen the risk. I’m willing to bet that managing stress would have a powerful impact on prevention.

While I did begin meditation at that time, had I started learning to deal with my anxiety and accompanying physiological responses years ago, I might have been able to sidestep the disease. There is science to this which I will cover in a later post, but my doctors *hate* it when I postulate possible causes of my tumor since if we could truly pinpoint the cause, we’d be able to cure the disease. However, given what we do know about stress and inflammation, I can guarantee that my stress response did not help in keeping me cancer-free!

In the Coursera class, Dr. Ali Seidenstein (NYU) explains, among other things, how the small positive changes that arise from learning to control the stress response by applying yoga and meditation affect your genetics. And this is key. While you’re born with a certain set of genes, the science of epigenetics describes how you can affect gene activity (think, turning a gene on or off) and thereby have a different outcome from someone else with the same gene.

Finally! Something that *I* can do that provides a rare sense of control in an uncontrollable situation! For a cancer survivor, this offers a nugget of hope to hold on to in the face of continuing medications that may or may not help your survival. Medicine is tested on a variety of individuals but there’s no guarantee that their success will translate into your own (news flash: cancer = no guarantees, period). But knowing that you can engage in behaviors that, when applied over time, will actually benefit you on a genetic level…that, my friends, is priceless.

Revisiting Yoga After Cancer: Finally Coming Around

Decades ago, my introduction to yoga took place in my parents’ library, a small paneled room with wall-to-wall, floor-to-ceiling books. There I found an illustrated guide, replete with black and white photographs of odd contortions and strange nasal flossing. It seemed weird.

I had barely begun elementary school, and at that age was a natural-born yogi, as many young children are. Lotus pose? I could get my legs into position without using my hands. King Pigeon was no big deal, and nothing hurt when I folded myself up. I didn’t have a regular yoga practice at that age, but I would get occasional exposure to yoga moves at school, and I imagined all yogis wore diaper-like pants and lived on mountaintops.

High school provided an opportunity to do more. One of our French teachers practiced yoga, and I took a season of classes with her. Really, I remember little from that time. At that point, I was still limber but not as lanky, and yoga wasn’t particularly exciting. Volleyball was my game and I had no appreciation for how yoga could improve my playing. Had I practiced it properly, yoga could have helped immeasurably and prevented many a lost serve. But I lacked introspection and so barreled on as before.

Yoga resurfaced in my life now and again, but obsessed with more active ways of sweating, I steered away from it. I swam, ran and eventually strength-trained my body into shape. Yoga didn’t have a place in my view of what fitness should be.

Holding poses for a prolonged time? Not for me. Sweating through hot yoga? You’ve got to be kidding. A friend sustained a serious back injury from a yoga teacher who tried to force her into a pose. That was it; I was done with the idea of incorporating yoga into my already packed fitness routine.

Then I got cancer.

And I realized that my mind was victim to free-ranging anxiety. Desperate, I immersed myself in learning to meditate. I know they say that you need to find calm in the midst of chaos, but being thrown into chaos is not the best place to learn to be calm. I limped through cancer treatment and clung to the hope of peace. The only relief came from my love of fitness and drive to exercise as soon as the worst side effects of each infusion had passed.

Still, I pushed yoga away. Not interested. I needed to get my body back to where I’d been pre-cancer, not do slow movements that might tweak something and burned too few calories.

But the more meditation I did, the more mindfully I moved, yoga kept coming up, like a refrain in a song. Movements paired with breath.

And then, it hit me. Movements paired with breath. I was all about the breath by then. Yoga provided the movements. And I found bliss.

When I opened myself up to yoga and invited it into my workout routine, something magical happened: my body started stretching out. All that tension that I’d carried for decades that had gradually tightened me up started releasing. My fingers found the floor in a forward bend again, and gently brought my palms with them. My heels easily pressed against the ground in a downward dog, with little peddling required. Moves that I could once do became available to me again.

So here’s the thing about breast cancer: after surgery, you lose some mobility in the affected side. Even now, side bends stretching my left side “pull” uncomfortably compared to my right side. Anyone who’s had lymph nodes plucked out of their armpits knows that that area stays tender for a good long time. Often, this brings an imbalance to the body.

My workouts had consisted of pounding myself through rowing, conditioning intervals, strength training with heavy weights and swinging kettlebells around. But without yoga, something critical was missing. Initially, I was afraid that “sacrificing” exercise sessions to yoga would result in faster decline of my physical ability and a push towards a more sedentary existence. Oh, how wrong I was! If anything, yoga has moved me towards vitality, flexibility and a sense of youthfulness that straight strength training had never allowed. Yoga opened up my whole body and allowed it to breathe freely.

What this has offered me is another way to look at how my cancer journey is progressing. After the aches and pains associated with never-ending adjuvant therapies, I admit I felt it was all going to be downhill, and that all I could do was desperately cling to my workout routines as my abilities gradually slipped away. Yoga brought back an element of fitness that I’d forgotten, and now, even though I know that I will be lifting less and rowing slower as time goes on, there is a new, perhaps more gentle world of fitness that I have yet to fully discover.

Online Classes: Yoga and Science – Putting It All Together

Please note: I’ve included links to various items below, none of which I’m compensated for. If I’m writing about them, it’s because I think they’re excellent and worth recommending to others.

In my never-ending quest to bring more peace into my life, and with the extra time I’ve found in COVID-19 lockdown, I’ve been taking advantage of online class on platforms such as edX and Coursera, and have been impressed with the breadth of courses that are available.

Currently, I’m mid-way through a class on Coursera from New York University (NYU) connecting yoga and science, called “Engineering Health: An Introduction to Yoga and Physiology,” and I am thoroughly enjoying it. This class can be audited for free, or $49 gets you access to the quizzes, a certificate once you’re done (that can be posted on LinkedIn) and no time limit on access to the materials.

The course is taught mainly by three individuals: (1) Prof. Alexandra (Ali) Seidenstein, lecturer and research scientist in the Chemical and Biomolecular Engineering Department at NYU, who is also a yoga teacher; (2) Eddie Stern, NYC-area yoga teacher and author, co-founder of the international Yoga and Science Conference and creator (along with Deepak Chopra, Sergey Varichev and musician Moby) of the highly-rated Breathing App for mobile devices; and (3) Prof. Tommy Lee, senior lecturer in the Chemical and Biomolecular Engineering Department at NYU. In addition, there are interviews with other scientists who have studied or made use of yoga in their research. For me, as someone who’s always looking for scientific validation, this combination of yoga and physiology is very gratifying.

First and foremost, the class teaches basic physiology. If you took survey classes in high school and college, the material will be familiar, and it’s presented in a clear manner with lots of visuals. Topics include physiological systems such as nervous, respiratory, cardiovascular, immune, digestive and much more. Additionally, there are discussions of homeostasis, epigenetics, and the effect of stress on human physiology.

As a cancer survivor, I find it so empowering to see the science behind how yoga affects my physiology, especially strengthening my immune system!

But woven in between all of these topics are instructions on breathwork and yoga movements for beginners, and this is what really ties the course together for me. The yoga is expertly taught by Eddie and Ali, both of whom make the experience very positive and not intimidating. With each lesson, they take the time to connect the physiology topics with what is being taught in the yoga class. This is a novel approach that I have found very empowering: there is a direct link between the work being done in the yoga lessons with functioning of the body.

For me, making that connection leads to a sense of self-efficacy and patience with myself, as it is with consistency of practice that we make change. Even more than that is the feeling that I can affect my immunity against disease (and cancer?) by keeping my stress levels in check. I have always felt that stress played a role in the development of my cancer, and although I cannot prove this, knowing that there is good science behind using such relaxation techniques as yoga and meditation in prevention of inflammation and subsequent disease gives me a sense of control in a situation that has often felt completely outside my control.

As mentioned, I am only at the midpoint of this class. I look forward to the second half and will report back about my overall impression once I am finished. In the meantime, if this post has piqued your interest, I highly encourage you to check the class out!