Category Archives: lung metastasis

Again?!?

The last post I published was in September of 2017, three and a half months after my first cancer recurrence. If I’m publishing again, while it could mean many things, it probably only means one. Now, before anyone takes this too seriously, as of Monday morning, November 26th, I was out of surgery for a fast growing tumor to the upper lobe of my right lung, and am once again NED (cancer talk for “no evidence of disease”). At this point I’m feeling qualified to say that every time I’m diagnosed with cancer, it’s a different experience. The first time, I charged in with the beautiful, naive optimism of Joan of Arc, certain that fearlessness and fortitude were all I needed to knock cancer soundly on its ass. The second time, soul weary and not quite recovered from round one, I muddled through in a haze of depression and defeat. This time, the third, has shown itself to be something altogether new, because now I’m starting to develop cancer wisdom, or as I’ve taken to saying, I’m a frequent flyer in a super sucky miles program with questionable rewards.

Since January of 2017, I’ve gotten a CT scan every 3 months. In the beginning, it was to follow the sketchy speck that became my first cancer recurrence, and afterward, to err on the side of caution. From July of 2017 to November of 2018, I had 6 clean scans. Nothing to see here, not a single change, not a twinkle in my tumors eye. Life was good, and I was going like gang busters. My schedule in the studio picked up to relatively full time, the prescriptive exercise pilot I presented to the LIVESTRONG Cancer Institutes at Dell Med School was moving forward, and I was strong, happy, and in love. I got comfortable, so comfortable in fact, that when my oncologists office was running painfully behind the day I was to get my most recent scan results, I abandoned their waiting room to go to the studio, and told them to leave a voicemail if I didn’t answer. Their voicemail went something like this, “we would still like to offer you the chance to come in to get your results in person, anytime you are available. You can call ahead or walk in.” A voicemail like this from any doctors office is the equivalent to being moved into the private room with a view following your colonoscopy, bad news is on its way.

I got their voicemail about 4 hours after leaving the office, and like any sane person, I drove straight to Neiman Marcus to get my gown for a close friends wedding the following weekend in Mexico City. What did you think I was going to say? That I went screeching into Texas Oncology? It is very important in life that one knows how to prioritize, and if you’re going to get crap news like having cancer again, then knowing there’s a brilliant dress hanging in your car really does soften the blow. After I picked up my dress I drove down the road to my oncologist office. And then sat in the parking lot deciding whether or not to go in. You can’t hide from the truth forever, but it never hurts to try for a minute.

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This is the back of said gorgeous dress. The front will come in the next post when I describe how I learned what it’s like to deal with this disease in a somewhat new relationship. I’m sure my boyfriend will be super psyched about that. (just imagine the hanging strap peaking out from the back tucked all the way in).

So there I was, by myself/alone/flying solo in the waiting room for the first time in nearly 3 1/2 years (someone who loves me had always insisted on coming with), and for the first time ever in that waiting room, I wept. Having never cried before when I got the news, this felt like a somewhat delirious luxury, to let emotion spill out and be a little angry that my cancer won’t just go away and leave me the fuck alone. I didn’t cry because I was afraid of what was coming (I’m not scared of much anymore besides snakes), but because of what I knew would be coming: pain, fatigue, recovery, rehabilitation, more scar tissue, and one more, hopefully mild, bout of depression. I was crying because I was getting prepared, and I was crying because my life is about staying prepared. I was crying because having cancer sucks.

A perk in oncology is the speed with which they give you news. I think I waited all of 5 minutes before being ushered back to Dr. Yorio’s office (which means my cry in the waiting room probably lasted about 3 1/2, no need to drag these things out), and then maybe waited 2 minutes for his soft tap on the door. In the last 3 months, with no warning, a small lesion had flourished in my lung, growing to the small size it had taken its predecessor almost a year to reach. Previously, my cancer had been described as indolent, meaning it was slow growing, a bit lazy. There was comfort in this, probably because it gave me the illusion of time. That buffer was nonexistent when my oncologist told me there was a 1 cm lesion in the upper lobe of my right lung, and we needed to schedule surgery. 0 to “here we go again” in 30 seconds. The speed with which the new cell had grown threw me, and continues to throw me, for a real loop. It was new, and I’m learning that when it comes to my cancer, I don’t like new.

This was 3:45 pm on the Monday of one of my most anticipated weekends in years. On Thursday of the same week, many of my best friends in the world and I and my beau (heart hands), were leaving for the wedding in CDMX, and returning late the following Monday, which just happened to be the week of Thanksgiving. Fast growing lesion, time to celebrate, Thanksgiving holiday. What do you do? Go numb, act quickly. I had an appointment with my thoracic surgeon less than 48 hours later, and a wedge resection scheduled for the Monday following Thanksgiving. He assured me that this lesion was better located for removal, they had better eyes on it, and this should be an easier surgery to recover from. Walk in the park? No. Because even with easier lung surgery, lung surgery is lung surgery, but less bad is always good.

Here’s what I knew, I was much stronger than I had been when I had lung surgery in 2017, in a far better place mentally and emotionally, and reasonably knew what to expect. I was as prepared as you can be when you’re unprepared. What didn’t I know? How to share this news with my relatively new suitor who is also an old friend, or how this diagnosis triggers me in a way that I can’t hide so well from the person sleeping next to me. This was as new as my fast growing lesion, and I’m not entirely sure I was very good at it.

 

*Welcome back, friends! I’m going to try an experiment in keeping this blog updated in 2019, some posts I will share to social media, and others will just go up, so if you have any interest, check in on occasion.

 

 

Yes, You Should Move During Chemo

I’ve thought a lot about where the motivation to be physically active throughout cancer treatment comes from. At some point, and maybe multiple points, you are going to feel like absolute garbage. If you’ve had radiation, you might have burns, if you’ve had surgery, you will have incisions and bruised insides, and if you’re undergoing chemo, there are a whole hosts of side effects that could potentially arise, none of them desirous. If you’re doing any combination of the above, along with a number of treatments I have absolutely no experience with, well then, as we say in Texas, bless your sweet heart. So how, and even more importantly, why, in the midst of all this, will you find yourself motivated to move? Because movement is medicine.

Hopefully, you’ve already been practicing pre-hab, i.e., pre-rehabilitation meant to strengthen the body and improve endurance in preparation for a surgery, illness, or medical procedure that will likely require re-hab. You’re already in the habit of moving in a way you enjoy, and it makes both your brain and body feel good. But, the big but, you’ve hit the point where you don’t feel well in ways that you didn’t know you could feel bad, and you don’t want to do anything, let alone exercise! Do it anyways. Are you feeling muddled from chemo? Have you already forgotten two appointments today, and can’t remember why you’re standing in the middle of your bedroom holding a pair of shoes and socks? Chemo brain is real. Research says so. Best treatment? Physical activity, as if you didn’t already know the answer. A recent study published online on July 4, 2017 (“The effects of physical activity and fatigue on cognitive performance in breast cancer survivors.”) involving 300 breast cancer patients during active treatment, revealed that the participants who engaged in more physical activity each day than their counterparts demonstrated better performance on cognitive tasks measuring attention, memory, and multi-tasking. They also reported less fatigue. Depression and anxiety are among the most taxing side effects of cancer and its treatments, and a 2012 study directed by Dr. Karen Mustian, showed that 10-45 minutes of aerobic exercise 4-6 days per week was enough to significantly reduce not only anxiety and depression, but sleep disruption, too, which is also a common side effect of cancer treatment. As well, a more recent study by Dr. Mustian showed that a walking program and gentle resistance-band training at home reduced the chronic inflammation that’s common in cancer patients receiving chemotherapy. Starting to feel the effects of neuropathy? Maybe your extremities are always tingling, asleep, burning, aching, numb, or clumsy? Studies show that exercise is one of the best ways to reduce the effects of peripheral neuropathy. And, as I’ve mentioned before, most importantly of all, research also indicates that physical activity during and after infusion helps to deliver chemo drugs to the tumors when they are most readily available in your body by increasing vascular normalization. Huh? The researchers say it best, “Tumor vessels are highly disorganized with disrupted blood flow impeding drug delivery to cancer cells… We show that moderate aerobic exercise with chemotherapy caused a significantly greater decrease in tumor growth than chemotherapy alone through improved chemotherapy delivery after tumor vascular normalization.” (Tumor vessel normalization after aerobic exercise enhances chemotherapeutic efficacy). Could “greater decrease in tumor growth” possibly be so simple as taking a few short walks a week? Yes, apparently it is.

Importantly, each side effect that you are effectively able to improve increases your chances of completing your entire treatment protocol, thereby improving your overall response to treatment AND your cancer experience. Trying to have a decent cancer experience should be a thing, and movement is a huge part of that thing. Physical activity is kind of like that wonder drug that we always want, the one pill that will address multiple issues at once without creating more unwanted reactions. There are pills for neuropathy, sleep, depression, and fatigue, but I can promise you they don’t work as well as exercise. It is low cost, self-driven, simple, and one less foreign substance moving through your body. And the absolutely, positively, most fantastical finding about physical activity in cancer patients, is that it doesn’t have to be hard or vigorous to be effective! This is not an ass-kicking, no pain no gain, harder/faster/tougher mentality. At all. Consistent and moderate are the words you see over and over. This is an act of kindness for your mind and body, so treat it as such. The majority of this research has been done utilizing moderate aerobic activity, like walking, and gentle resistance band exercises, and most often given as a home exercise program to patients. The key to unlocking the treasure trove of benefits as you go through treatment is simply to stay physically active.

If you are unsure of where to begin, always discuss starting a program with your oncologist(s), and if you’ve started feeling generally funky and don’t know how to safely continue, once again, speak with your doctor, and maybe schedule a few visits with a cancer rehabilitation PT, or an exercise physiologist who has expertise in working with cancer patients. There are so many resources available! Here are a few ideas to get you started:

  • In the infusion clinic, at least once an hour, get up and take a couple of laps. If you feel unsteady have a friend join you, or grab a volunteer, but help your body move all those drugs through your system! Personally, I found that this helped my nausea a bit, but that might not hold true for everyone
  • Purchase a pedometer. I’ve found multiple online for less than $10. Whether you set a goal of 10,000 steps a day, or 5,000, research indicates that most cancer patients are walking far less each day than they were prior to diagnosis, so check your steps!
  • Theraband is also relatively inexpensive and can be purchased online. Buy a couple of resistance bands, and take them to the infusion clinic with you, or keep them at home. Sign up on the Thera-band Academy website for a gazillion exercises that may be done in sitting with a resistance band. This is a great way to maintain strength and flexibility.
  • Do it yourself. Put laundry in the washing machine, go to the grocery store, plant gardenias, dust your furniture. These count as physical activity, and you’ll watch yourself racking up the steps!
  • Rest as necessary, none of this is meant to wear you down further.
  • Don’t rest all the time.
  • Remember that movement is medicine.

 

 

A Case for Exercise Throughout Cancer

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November 2015. In the studio 1 day after chemo, and looking a little nauseated. In fact, I’m quite sure I was nauseated, but moving around always lessened it a bit.

It will come as a shock to no one that I’m a huge believer that movement heals, and should be considered an integral part of almost all cancer treatment programs with rare exception. The human body is a dynamic machine whose mechanisms thrive on the power derived from the processes initiated by physical activity. Last year, the following headline validated much of what I have preached throughout my cancer experience: Exercise is the Best Cure for Fatigue Caused by Cancer. I believe my exact response was an eloquent “duh,” and from there I dove down the rabbit hole of investigating the importance of exercise before, during, and after cancer treatment. What a thrill it was to find myriad scientific articles and studies proclaiming that not only was exercise a good thing for cancer patients, but that oncology rehabilitation “must” be a component of survivorship programs.

I learned that in places like New Zealand and Australia, depending on the chemo drug administered, they will escort patients directly from the infusion clinic to physical therapy because there is evidence to show that exercise may increase blood flow to tumors at the time when the drugs are most readily available in your body. That there is irrefutable evidence that exercising during treatment reduces the severity of side effects with certain types of cancer, increases the likelihood that the full treatment regimen will be completed, and increases life expectancy by up to 28-44% after particular cancer diagnoses. On multiple occasions, I have been nonchalantly informed that because of the 29 rounds of radiation to my pelvis during the summer of 2015 and subsequent chemotherapy, I have an almost 100% chance of suffering a spontaneous hip fracture by the time I’m 75. This sounds horrifically painful. Apparently, chemotherapy may cause a woman to lose as much bone density in one year as she would in a decade. What is the best way to maintain or improve bone density? Weight bearing exercises. Many patients suffer from peripheral neuropathy, an uncomfortable and potentially dangerous side effect of chemotherapy, in their hands and feet. The condition may cause tingling or burning in the extremities, making sleep elusive, and/or loss of sensation leading to falls and fall-related injuries. One of the best ways to treat peripheral neuropathy, especially early on, are exercises that increase blood flow to the peripheral nerves to improve sensation, and activities that improve strength and mobility to decrease fall risk. Infinitely more simple than the drugs often prescribed with side effects like drowsiness and dizziness. Cancer patients don’t really need anymore of that.

To boot, exercise may also lessen nausea (woohoo!), decrease feelings of anxiety and depression, improve your ability to maintain a social life, decrease fatigue, and improve your ability to take care of your own needs. While it is always lovely and heart warming to have friends and family care for us, it’s important to your spirit and sanity to maintain a sense of independence, even if it’s just doing your own laundry and grocery shopping. Exercise is proactive, and inspires a sense of self care and personal empowerment that helped me to feel in control in a situation that often makes you feel vulnerable and helpless. And please keep in mind, that while I have written the word “exercise” roughly 1,001 times in this post, that could mean a languid walk around the block, or perhaps even the infusion clinic. It’s all relative, but as you can see, the clinical evidence for oncology rehab is screaming at us, and it’s screaming at us to move.

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January 7, 2016. I was wearing my chemo pump this day. I can see that blurry, dulled look in my eyes, but it was a beautiful winter afternoon, and those should always be given the appreciation they deserve.

To most people all this jumping up and down (haha) about movement seems like a no-brainer. Of course it makes sense, but for many, many years of cancer treatment, patients were told not to tax themselves, and everyone knows the treatments make you profoundly exhausted. Exercise becomes counterintuitive, but the less you move the less you want to move. I really, really love Sir Isaac Newton’s first law of motion:

Every object will remain at rest or in uniform motion in a straight line unless compelled to change its state by the action of an external force.

Or, bodies at rest stay at rest, bodies in motion stay in motion. If you’ve been at rest too long, you must exert a little external force to get moving again. It’s science. As well, in the midst of the insanity following a cancer diagnosis, exercise often takes a back seat to all of your appointments, treatments, and general life management. Hear me when I say that in many cases exercise is NOT a luxury, it’s treatment. Refer to clinical evidence above.

It is important to consult with your doctor before beginning any exercise program, and this is even more true for cancer patients. Certain types of bone cancers increase risk of fractures, some chemo’s are known to lower blood pressure for a few days following infusion, some people develop peripheral neuropathy that may increase risk of falls or injury, and some people might have compromised immune systems that preclude time in the gym. For these and numerous other reasons, you want to speak with your doctor and make sure you’re safe, but once that’s done, there are many advantages to implementing a program, keeping in mind that for the cancer patient the intensity and/or types of activities may change daily based on their ever changing cancer body.

In the following weeks we will look at how to get started, different types of exercise that might benefit you or your friend with cancer, and some general guidelines on movement.

As always, thank you for reading!

Being the Mess

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A sample of the things that made having someone dig around in my lung not quite so bad.

“Sometimes, I’m the mess. Sometimes, I’m the broom. On the hardest days, I have to be both.”–Rudy Francisco

The cancer metastasized. One little nodule that popped up on the peripheral edge of the lower lobe of my left lung in October, and was growing by late April. The risk of metastasis was always there. The correlation between how low your rectal tumor is and spread to the lungs is significant, and the late stage diagnosis meant that quite probably more than one microscopic cell had caught a ride on the lymphatic highway leading to my liver and/or lungs. Despite knowing all this, it never crossed my mind that the adjuvant chemotherapy they did following surgery hadn’t annihilated each of those tiny invaders. It had most certainly come close to annihilating me. They aren’t really invaders, though, are they? Isn’t it just the same process that makes us grow in the womb? Cells dividing multiple times over, except for these are altered, and they are the enemy.

Initially, because of the positioning of the nodule above my diaphragm, my doctors didn’t know if the lesion was cancerous or not, but it was growing, they had confidence that they could locate and resect it, and eventually consensus was that it needed to come out. I imagined them apologizing profusely for cutting me open only to find a benign spot of pollen on my lung, and pushed the thoughts of malignancy so far down that for a couple of weeks I thought I might go crazy with the effort it took to conceal this possibility from myself. Always pragmatic to the outside observer, I told those who were bold enough to ask that I was prepared for it to be malignant, because that’s what strong, courageous people say, when in truth I was telling myself completely the opposite. You see, I’m actually a bit fragile, and I wasn’t mentally prepared for this, but losing one’s mind isn’t an option for the middle class.

Hearing the lesion was metastatic threw me into a dark tailspin, the greatest fear being that this is the beginning of them cutting pieces out of me bit by bit until there’s no more left, because doesn’t every tragic cancer story begin with mets to the lungs? And the greatest frustration being that this was one more setback to overcome. I was mad and sulky and apocalyptic about my life. This was supposed to be over. I had done my time and been paroled only to be thrown into the clink again. Except cancer is more like the super-max New Mexico state penitentiary in Santa Fe than anything that could ever be called the “clink.” It has a dark, heavy current of pain, grief, and fear that I had purposefully chosen not to explore my first time around. I was a goddess! I was going to rise above! Whether I was chronically nauseated, cut from pubic bone to sternum, or stumbling around because I couldn’t feel my feet, I grabbed onto any sliver of light I could find and created a blinding sun. It worked at the time, but apparently the universe felt that I hadn’t fully examined the shadows of my emotional depth, and decided to invoke it’s no stone left unturned clause. Tyrant.

Last week the word “submit” kept coming up: in an article written by a young woman who recently died of Ewing’s Sarcoma, by a dear friend at her book signing (“White Fur” by Jardine Libaire is this summer’s must read), by the Dalai Lama in an audiobook. I know how to take a hint. I’m practicing submission to this new rhythm of my life, anger and annoyance included. There will be scans every three months for a long time, if they cut me open I will heal, we will watch and wait, and in the meantime I will keep myself as healthy as possible because that is probably what has gotten me this far in the first place. Somedays I will be the mess, and I’m alright with that because I’ve been the broom for a long time. I continue to believe that this will potentially be the last cell to activate, but I won’t delude myself with the possibility that it won’t. Those tiny little microscopic cells are lying cozy and dormant in my spongy lung tissue, we are traveling companions, and I can accept this, but they don’t get to take over. I love what Elizabeth Gilbert once wrote about fear:

I recognize and respect that you are part of this family, and so I will never exclude you from our activities, but still—your suggestions will never be followed. You’re allowed to have a seat, and you’re allowed to have a voice, but you are not allowed to have a vote. You’re not allowed to touch the road maps; you’re not allowed to suggest detours; you’re not allowed to fiddle with the temperature. Dude, you’re not even allowed to touch the radio. But above all else, my dear old familiar friend, you are absolutely forbidden to drive.

Currently, I’m getting focused on exercise oncology. My brilliant lung capacity made this surgery possible, the fact that I rehabilitated myself past pre-cancer strength allows me to recover not only quickly, but well, and I’m reading some fascinating articles about how exercising during certain types of chemo is actually recommended to help the drugs do their job. I have developed a very specific skill set (when life gives you lemons) revolving around surgical recovery, exercising through fatigue, and how to do Pilates with a chemo pump. I’ll be writing more about all of these things, and probably more about how I’m learning to submit. Rome certainly wasn’t built in a day.

Xo, Shelby