Prescribing exercise?

I am very lucky - I've been treated for my breast cancer by a hospital that takes exercise seriously.  Twice a week, throughout my treatment, I have attended an exercise class with other women in various stages of their breast cancer treatment.  But today I heard that the course might be under threat because the hospital cannot get funding.

That raises the question: Should exercise be provided as part of the prescribed treatment for breast cancer?

The science is certainly there to show that regular exercise reduces the chances of breast cancer recurring.  I have to admit, however, that there is little scientific about the class I attend at hospital: we do some abdominal and weight exercises and use the cardio-vascular machines in exactly the same way as most Bums and Tums classes and workout regimes.  So should the hospital provide something that could be found at any regular gym?

I strongly believe that the answer is 'yes' and it's less about what we do and more about the environment.

First, it is deeply reassuring to have physios overseeing our exercise routine.  I didn't need to have specific appointments with a physio after my mastectomy because I was seeing my physio twice a week at my exercise class anyway.  And she was still there to advise me a couple of months later when the problems with mobility in my left arm resurfaced.  She was there to reassure me that it was fine to take part in the exercise for my arms without worrying about lymphedema and she told me how to keep going when I was in the middle of chemo and just looking at an exercise bike sent my heart rate through the roof.  Now that I have finished the active treatment and headed into a period when it is known that women often suffer from depression- she's still there with her bounce and enthusiasm to encourage me on my way.

Meanwhile, I have also done the journey alongside a good crowd of other women going through the same process: we compare the hair appearing on our bald heads, encourage each other when times get tough and keep each other going when the slog all seems too much.  After all, if they could keep going through chemo, then I knew I could too.

Yes, I could have joined a regular exercise class and doubtless met another great crowd of women.  But would I have been brave enough to take my bald head to a class of gym bunnies with nice hair, to keep turning up when the exhaustion of chemo meant I couldn't really keep up, to try arm exercises when I was terrified of lymphedema or to reveal my lopsided shape under a gym T shirt when my radio-burnt skin meant I couldn't wear a bra?

Probably not.

Whereas now, I am physically more confident, my hair is regrowing, soon I will be able to wear my bra again so no-one will know my curves are not my own and I've even got some muscle in my arms.  I've learnt to love my bi-weekly exercise hit rather than seeing it as a necessity and, when my hospital course comes to an end, signing up for a regular gym will be a priority. 

So, as a result of my relatively inexpensive hospital-organised class, I am much more likely to incorporate regular exercise into my regime which will reduce my chances of having to come back for expensive chemo and radiotherapy treatments by an amazing 25%.

That's got to be a good investment, hasn't it?

So How Was Radiotherapy?

It was April Fools' Day but the nurses weren't kidding when they said goodbye - I have reached the end of a long road.  Nine months after my diagnosis at the end of June last year, I completed my last radiotherapy session on April 1st. Nine months?  Was it really so long?  Time has taken on that strange quality when it seems impossible that I have lived under the shadow of cancer for so many months and yet, at the same time, my diagnosis feels a lifetime ago. I have posted rarely during the last few weeks for the simple reason that radiotherapy has bitten deeply into my free time: the hospital was a good 40 minute drive on good traffic days and having daily treatments means the days vanish quickly.  But that was merely a logistical issue.  The radiotherapy itself has been quick, easy and painless.  Every day I arrived at hospital, got my hospital-issue-but- fluffy dressing gown out of my locker (not sure the NHS would give this arriving-at-a-spa feeling, my Europa hospital here in Brussels felt decidedly posh).  Most mornings I had a short wait before being called into a cubical to strip to the waist, put on the dressing gown and continue through to the radiotherapy room itself.  They would prepare the table so that I could take off the dressing gown and lie on my back with my arms up behind my head on supports.  The most difficult part of the process was getting me in position with several staff pushing me a fraction this way and then that while beams of infra-red light bounced weirdly on the lines painted on my chest.  It seemed a millimetre-precise process so, once in position, I had to stay very, very still.  There was a lovely photo of trees lit by sunshine on the ceiling of my radiotherapy room: I am now familiar with pretty much every twig. Not that the zapping bit took that long: everyone else would clear the room and then the machine would move around and make killer-robot-gun noise at me, fortunately entirely painlessly, for around twenty minutes.  Then everyone would bustle back, let the table down and that was that. And side effects?  I saw the radiologist for a last check up this week and he had a long list of questions.  Do you have swollen hands?  No.  Pain in the armpits? No.  Respiratory problems?  No.  Bone pain?  No.  Redness on the skin?  Well, a little bit.  Soreness?  A little sensitivity: as if I have sat in the sun a bit longer than I should.  But dryness, flaking skin, itchiness?  No, none of the above.   It made me realise how many possible side effects there are and how (almost embarrassingly) lightly the radio seems to have affected me. And finally, fatigue?  Like at the end of chemo?  Well, yes, I'm pretty tired.  But bone-draggingly exhausted like back in early Jan when I'd look at the stairs and wonder if I could make it to the top?  No, nothing like that.  And to be completely honest, the few hectic weeks have been decidedly socially hectic so I'm not too surprised to feel tired. My skin is now fragilisé as they say here, so I will need to use lotion on it for the rest of my life and be a bit extra careful with the sun.  But all in all, the radio couldn't have gone better.  Has it worked?  Its purpose is largely preventative so only time will tell - but the doctors are confident that the chance of recurrence is as low as it could be. Next: Tamoxifen. I took my first tablet nervously.  Who knows what side effects the next few weeks will bring? I know that some women find this part really tough.  And others don't.   As always, the scariest thing about cancer treatments is the what ifs...  So all I can do is swallow the pill and be glad that I don't have to drive anywhere and sit in waiting rooms for this part of the treatment. Meanwhile I was rather shocked to walk out of my oncologist's office and realise that I have NO MORE doctor's appointments until my first check up in July!  It feels both liberating and terrifying to be let loose alone in the world without a doctor to hold my hand.  My oncologist recognised the mixed feelings, however.  He warned that the next few months, just when you would expect cancer patients to be wild with joy, can often be a period of depression.  I guess we have to shift from fighting mode, from being the rock-star-status-cancer-victim among our friends, to getting on with normal life again.  If we can remember what normal life looks like. Fortunately my lovely hospital tries to help with this by continuing to offer twice weekly exercise classes, so I get the benefit of exercise (and amazingly I always feel better about everything after a class despite being very non-sporty all my life, what a revelation!) as well as seeing other cancer ladies and not having to wean myself off the comfortingly familiar smell of hospital corridors just yet. Better still, thanks to the classes I am in better physical shape than I was nine months ago when I was diagnosed.  My hair continues to grow - I have a dark, shaven-jailbird hairstyle just now, not quite ready for public viewing yet but getting that way - and my eyebrows (once down to three hairs in total) and eyelashes (which went entirely) are nearly back to normal.   And I'm sitting peacefully at my computer with a cup of coffee without having to rush to get out the door for my next appointment.  I don't know what cocktail of emotions will hit me over the weeks to come but right this moment, life feels good.

I Don't Want to Slow Down!

 "I can't do anything!"

My cry of frustration came at my hospital exercise class.  I was on the exercise bike, pedalling ridiculously slowly, and my heart rate monitor was already beeping warningly.

"You need to slow down," the physio told me reprovingly, seeing my heart rate zoom well over my 'safe' range'.

"But I am going slow!" I wailed.

She looked more closely and asked, "When did you last have chemo?"

The truth is that weekly Taxol provides no opportunity to take a break on chemo days or you'd never do anything at all.

I shrugged sheepishly and confessed, "This morning."

"There you go then," she said with an exasperated sigh.  "Slow down!"

But I don't want to slow down.  I have two primary-aged children who are full of primary-aged energy and want me alongside them.  It's almost Christmas and I want it to be a 'normal' Christmas.  I want to help at my daughter's school Christmas party while she is still young enough to want me there.  I want to make mince pies like every other year.  I want to have a fun school holiday.

So the first day of the school holidays I plan to take the kids for a long promised trip to the ice rink.  I ask a good friend if she and her kids would like to come with us.

"Are you sure it's a good idea?" she asks me.  She knows I had chemo the day before and I'm now also on a course of Neupogen shots because I'm heading towards neutropenia again.  She knows that I did help out at my daughter's party and went to my husband's office party... and that I'm utterly exhausted.  "You're tired and it'll be cold, not good for aches and pains."

But I am determined so she agrees to come along.  It's utter chaos when we get there: everyone else had the same idea and the ice is packed.  It's exhausting just getting through the crowds to get our skates and the noise is unbelievable but soon I'm on the ice with the kids and having a great time.  We hold hands and go in a long line together.  We go one behind each other and make a train.  We do loops and try to go backwards and soon they want to play tag like we usually do.

But all of sudden I have a problem.  I can't see.  This isn't a new chemo side effect, it's an old friend come to visit, one I haven't had for a long time but I know all too well.  There are flashing lights in front of my eyes and I have a migraine coming on.

I stagger off the ice and thank my lucky stars that my friend came with us: she finds me paracetamol and water (I don't even have any pain killers on me, how stupid is that when I should at least have been expecting bone and muscle aches?  I am living in denial of my sick person status perhaps).  I breathe deeply and find that eases the problem, perhaps it was just over-exertion after all. 

I feel better and offer to take all the kids home to my place.  Gently but firmly my friend insists that they are all going back to her house.  On the one condition that I go home and sleep.  I protest but not too vigorously and when I get home I realise that she is right.   I fall straight into bed and sleep for two hours straight.

When she brings back the kids she says, "You need to slow down."

Well, maybe.  I'm certainly glad that I didn't take the kids ice skating on my own as originally planned.  But I'm also super glad that I made it on the ice with them and had some fun, for a while at least.  So, what's the moral I am taking from this story?  Life doesn't have to completely stop while you do chemo - if you feel well enough then you should keep doing as much as you can.

Just take a friend to make you slow down when you are doing too much.

Keep Moving!

Twice a week I drive up to the hospital and head down to the gymnasium in the bowels of the building.  Usually when I arrive, the previous exercise group is just finishing up but I can always tell who is in my group: the other group has babies and bags under their eyes, my group has headscarves and wrinkles.  It really doesn't seem so long ago that I was in the antenatal group myself...

My group are a jolly bunch, all things considered.  Sometimes someone has to sit down for a bit because they feel dizzy and none of us exactly drip with sweat due to exertion but we all have a go and a bit of a giggle at the same time.  Not bad when most of us are doing chemo, some have metastasised breast cancer, one has ovarian cancer, all of us have been under the knife.

We do the machines first and I always get frustrated because I have to go slowly or my heart rate flies up.  Apparently this is because of low red blood cells: the heart has to work harder to get enough oxygen around the body and so the physios circle round us reminding us again and again to breathe.  Then we do some work on the mats, the sort of small movements that look easy but cause agony by the time you've done it twenty times. Picture a hall full of women of a certain age wearing headscarves and attempting to exercise with strips of elastic and ankle weights...we must look hilarious.

And why does the hospital provide these sessions?  Because research has shown that physical exercise reduces the chances of the cancer returning.  Significantly.  In the old days they were always telling you to rest when you were on chemo, now the advice is to keep moving.  And it makes me feel better too: often I don't feel like going but I always have more energy afterwards.  Today my muscles still have the Taxol ache but at least they have a good reason to ache now! 

I have to confess that, before all this, I was getting a bit on the middle-aged flabby side.  Is it possible that I'll end up in better shape than I was before my diagnosis?  I can live in hope.