Episode 17 Shownotes - Living Well After Cancer by Improving Strength and Fitness

You are listening to Best Life After Cancer, Episode 17.

Hey, my best lifers, and welcome back! This month we are spending the month focusing on living well. Whether it is during treatment, right after, or 5 years down the road. We can work every day on living our best lives where we are in the moment. The housekeeping first - As always, I am a doctor, but not your doctor, so especially when we are talking about what to do with your body and your health, please use common sense and run any recommendations by your primary team. A review would be awesome. I am trying to get to 100 reviews by Christmas, so give me an early Christmas present, and write one on Itunes.

I am writing this on Labor Day, while I am on call. I have a patient that needs to be emergently started on radiation today, so I am in my department. The process start to finish is not the quickest. While I wait for things like the patient to be transported from the floor, and other parts of the team to do their jobs to start a treatment, I am making the best of spending most of my Labor Day by creating something for the world. I could just sit here in the hospital, on my phone, playing a mindless game, or complaining about call to the doctor’s group on Facebook. But, that does not help me live well today. Resisting where I am or wallowing in self pity makes it take longer and feel worse. Doing something useful makes me feel a little better not being outside with my husband and kids. It’s all in how we think about where we are, right? I am choosing to think the time is well used, both for the patient, and for me personally.

Last week we talked about living well by improving sex after cancer. Today, we are going to talk about how to live well by working on moving our bodies in a helpful way to reduce pain, increase stamina and energy, and regain strength. There are two parts to this, which are our thoughts about how our body feels and our actions to try to maximize how it feels. I want to run through a quick scenario with you. If you have either pain or fatigue from treatment, the fact is that you have a feeling in your body that is not pleasant. If you have a thought of “this will never get better” or “this may be my new norm”, that often leads to a feeling of hopelessness. Hopeless is a feeling that does not drive positive action, because it believes that there is no available action that will improve the situation – by definition, hopeless is without hope. Without belief that things can change or improve. Hopeless drives lying in bed, your brain wallowing in a state of finding all the evidence that it will not get better, not searching for help, not following up on things that are suggested by the team, like PT or a fitness program. First and foremost if your body is tired or in pain, we have to look at what thought we are trying to use to drive improvement. We have to be in a place with a thought and feeling that can drive useful action. Why? Because we are more resourceful, harder working and more patient if we are coming at this from a more positive place.
From my standpoint, a better thought is “I don’t feel great now, but I know this can get better with time and work”. This gives a feeling of hopeful. It leads to actions like being motivated and willing to work. It allows one to search out options for improvement, like speaking with their team and following up on their suggestions. It does not waste time with indulgent emotions that don’t move us forward.
If you are in a place with a thought that is useful, awesome! Let’s move on. If you are not, I suggest spending a few days writing about your thoughts, and seeing what they are and what they are creating. See if you can find a believable thought that can spur useful action, and then come back and listen to the rest of this. If you can’t get there on your own, I have openings right now in my one on one coaching program. Reach out for a discovery session.
Ok. Once we are in a place with thoughts that lead to useful action, we can move forward. Awesome. Now we need to decide, what useful action do we want to be taking to feel better physically? First, if there is pain, that needs to be addressed. Your useful action is to speak with your team, describe the problem, and see what they suggest. It may be PT. This is also true if there is tightness, lymphedema or overall weakness. PT is very effective in improving mobility of joints, which can really help with discomfort. It is also useful in reducing lymphedema, which is swelling that happens after lymph node surgery or radiation. At the end of this podcast, I will spend 5 minutes talking about lymphedema, but as it is not applicable to everyone, I will hold that for the end. PT can also help with muscle weakness that makes moving your body much harder. Other useful ways in your arsenal to reduce pain include massage. This can help to loosen up tight areas and let you move more comfortable. If the pain is more significant, a pain management consult to discuss nerve blocks or trigger point injections may be appropriate. Again, speak with your team. But, let’s figure out pain first and foremost. An exercise plan is likely not something you can stick to if there is significant pain hindering you. Some thoughts I like that help move people along in this phase are “it’s worth the time and effort to help my body function as normally as possible”. Or “this may be inconvenient, but it is what will let me do more of what I want down the road”. Be patient, go through what they recommend first, even if you don’t think it is going to help after the first visit. These things take time.

Once pain, range of motion, and lymphedema are improved, then we get to addressing overall weakness and fatigue. I mentioned this briefly in the podcast on exercise, but I feel like it got lost in all of the other infomation. Many, if not most, patients, are less active than usual during their cancer treatment. This may be due to less time for exercise, not feeling well enough to do it, and more. When you don’t exercise for a period of time, you become deconditioned, which means you lose stamina and muscle strength. This leads to more fatigue and a feeling of just being weaker. It may make it harder to walk distances, run, bike, walk up stairs, and so on. Clearly, if you don’t get back to your baseline degree of physical fitness after treatment, you will not feel as good as you did before. Meaning, if you were walking a mile a day, and now you’re not, you won’t feel as good as you did until you get back to that level. Not just walking the same amount of time, but walking the same distance in the same time. It is challenging to rebuild your fitness. Definitely, talk to your team and see if they have any restrictions about exercise. If they say you are good to go, see if they have a cancer fitness program to help you build your strength back up. Start slowly, and work your way up. It is common to feel more tired the first week back at exercising. This is normal. Usually after the first week, the fatigue gets a little better. I think starting with 2-3 days a week is good. One is too few to build much momentum. 4-5 may lead to a degree of pain or fatigue that you don’t stick with it because you are too sore or too exhausted. I guess what I am saying, is be realistic. Too often, we decide to do it, and decide to start back immediately doing what we did a year ago. We push through, and do so much that the next day, our muscles are all killing us and we can’t do anything for a week. I can’t be the only one who does this, right? When you haven’t lifted or run in 6 months, and then you decide to, and the next day, you can barely get down to the toilet seat? If you have never done that to your body, congrats! If you have, you know exactly what I mean. When we do the too much – too little – too much – too little cycle, it is really hard to get any consistency and forward momentum. I saw a quote this week, from Rikki Rogers. Strength doesn’t come from what you can do, it comes from overcoming things you once thought you couldn’t. This is so true, both physically and mentally, of the journey to fitness after cancer. And one from me this week, the work you do today determines who you will be tomorrow.

When we exercise in a recreational way, the benefits are numerous. In the short term, it reduces depression and stabilizes mood. Over the long term, it improves energy, increases lean muscle, which increases metabolism, reduces risk of heart attack, diabetes, stroke, high blood pressure and cancer recurrence. It reduces stress. It helps with sleep, and can improve sexual health, both from improving how you think you look, to improving desire and arousal with regular exercise. It can be a social outlet, or relaxing after a stressful day. The type of exercise is up to you. The optimal goal is 150 minutes of mild to moderate exercise per week. Anything you enjoy is going to be easier to keep up. I most often recommend walking out doors. It is easy, free, and available to most people. The fresh air helps with better sleep and may improve your immunity. It is not hard on the joints like running is. Spending time in nature has been shown time and again to reduce stress hormones, which likely is very good after a cancer diagnosis. But it can be water aerobics, reasonable weight training, biking, vigorous dancing, like Zumba or salsa, swimming, and more.

How to start this is the challenge. Once you get going, you will find that actually doing it gets easier. At the start, we have to use the planning part of our brain, or the prefrontal cortex as much as possible. The newer part of our brain, the prefrontal cortex, is the part that can plan to do hard things that we don’t love, for greater benefit later. The older part of our brain is more instinctual. It is the part that in the minute says, nah, that sounds hard and uncomfortable. Lets sit on the couch, eat chips and watch Game of Thrones again. MMM – game of thrones, with a bag of Cheetos and a beer. Just saying it perks up that part of my brain, and now it’s saying, sure, sounds good, lets go! More fun than typing a podcast! But seriously, you need to do everything you can with your prefrontal cortex. Decide ahead what days and times you will work out. Set your clothes and shoes out. Maybe even get an insulated water bottle and fill it with ice for morning or after work. Minimize the amount of decisions you have to make in the moment. Already know and have set up what video, or exercise plan. Have it all ready. Set a timer. And a reminder. Maybe two. Then, when the timer goes off, just decide to get the clothes on. Then decide to fill the water bottle. Then decide to put on the shoes. Walk to where you are exercising, or get in the car. One baby step at a time. When your primitive brain starts fussing, remind it that you decided you were going to do this for yourself, and you keep the promises to yourself, just like you would to your best friend. Remind it how good you always feel once it is done. Then once you get going, the primitive brain may want to do more, do what you always did. It will say, I can do it. Let’s just keep pushing. The planning brain needs to be the adult here too. Nope, we planned 25 minutes, not too much the first day, and that is what we are doing. You get one day under your belt. Take a few minutes to notice how you feel, if you feel sore, or if you feel good. If you feel proud of your accomplishment. Bask in that glow a bit. If you are sore, assess. Is it good sore? Or too much sore? If it is more soreness than feels good, take care of yourself. A hot bath with Epsom salts. A rub down with a sore muscle cream. Motrin, if you are able to safely use that. Ice if something hurts in an unusual way. Rest the following day. Loving your body when it is sore helps to not get into the cycle of one day on, then quit for 3 months. Let your brain know it can trust you to help it through if it is uncomfortable after. A quote I love, that multiple people have been credited for is that some give up due to slow progress, never grasping the fact that slow progress……is….. PROGRESS. It is ok if it takes time. It is ok if it is challenging. The goal is to keep working at it.

But what if you don’t do what you had decided to do? Well, that is up to you. I find it a bit of balancing on a knife’s edge. You don’t want to just give yourself a pass, or else you will never build up the strength to do those hard things. But you also can not hate yourself into doing anything in life. If you beat yourself up, tell yourself you never keep your word, you use it as more evidence that you are useless, broken, unreliable, or whatever other mean things are in your head. Not useful. Not how you would treat your best friend or grandchild, likely. Instead, you can try to understand where the process broke down. Write down what worked, what didn’t work, what would have worked better. Then try again the next day. Was it that you turned off the alarm and didn’t get up? Move the alarm and work on just thinking I am going to get up, and turn off the alarm. Once up, then decide to get your workout clothes on. Was it that you stayed late at work and ran out of time? Look at how you could have managed your day better. This can be a reason to hate on yourself, or it can be a time to love yourself and see how you can support yourself better. I guarantee, you will get more results with loving yourself healthy, than hating yourself healthy. This week, I posted a challenge on the Best Life After Cancer Survivors Group, which is for survivors and caregivers. I will go live every day for the rest of this month, and tell you what I did to live well, and you post what you did. We will make positive changes by being accountable together!
I want to take a few minutes before we finish and talk about lymphedema. First, what is it? Lymph nodes circulate a whitish fluid through our lymphatic system. A simplified explanation of the system is that it traps bacteria, waste and damaged cells, and triggers our immune system to fight off disease. Cancer cells moving from where they started elsewhere in the body can get caught in the lymph nodes as well, which is why nodes are removed during many cancer surgeries. Lymphedema is when fluid collects in the extremity, or less commonly, in the breast or torso after lymph node surgery. It is most commonly seen after a node dissection in the underarm – most commonly for breast cancer, but occasionally from other surgery like a lymph node dissection for melanoma. It also can be seen with lymph node dissections in the groin area for some cancers. The risk is increased by number of nodes removed, number of nodes with cancer in them, use of radiation to the nodes after surgery, and obesity. So many people think that PT for lymphedema is only for people who HAVE lymphedema. But, I think it is really important to get an evaluation prophylactically if you are at high risk for lymphedema. In patients with an extensive lymph node dissection for breast cancer, or with some lymph nodes removed and radiation to the breast or chest wall and lymph nodes, the risk can be higher, and I personally have my patients evaluated up front, for baseline arm measurements, to learn massage techniques and to discuss the need for a sleeve. It is also an opportunity for patients to be educated about lymphedema and it’s prevention. Your team should discuss with you the specifics, but overall, we want to avoid injuries in the arm on the side of the node dissection. A few things that sneak up on patients that I like to point out are injury during gardening (think thorns and bee stings), and burns from the oven. Gardening gloves and oven mitts, my friends. Use them. If you think the arm is developing swelling, or is red or warm, speak to your team. Treatment is more effective early, and treating infection quickly is quite helpful as well.

Ok – that is it for today. Join me for the Living Well Challenge in the Survivor’s Group on my Facebook Page, Best Life After Cancer, MD! Tune in next week for an interview with an awesome survivor of an inflammatory breast cancer!