Thursday, November 1, 2012

A Year of Living Through Cancer Treatment

Cancer and Exercise

Part 1 in a 2 part series on life during cancer treatment

I dedicate this blog to my mom.  Let me tell you a story that began a little over a year ago...

The Background

My mom called me last September to tell me that she was having a "procedure" on her lungs, the "removal" of a small spot on her upper left lobe.  She really didn't think much about it, and in fact, wasn't even going to tell us (her children) about it.  She had lined up a friend to take her to the hospital where they would do the procedure and she would be out in 24-48 hours.  Mom lives in Florida, and all her kids live north of the Ohio River.  What hit me was this:  Mom was going to have a surgery on her lungs.  That sounded pretty major to me.  And this spot...what if it was cancer?  How would she feel getting this kind of news without family around?  So, I decided to go down and be with her for the surgery.  And, if it wasn't cancer, I just got to spend some quality time with Mom.  But, in the event it was, I was there for emotional support.

Mom was calm on the day of surgery, but had nervous energy that even she didn't recognize.  She talks a lot when she's nervous.  The surgeon came in, explained that the scans indicated the spot/mass was "hot" and explained the procedure.  Several hours later, I got a call from the doctor, who said, "It's melanoma."  I didn't really know what that meant (that's basically skin cancer and I was thinking, "Phew, that's a relief!")  However, doing my research on the computer, talking to friends and eventually, the surgeon, I realized that this was bad.  Anytime melanoma spreads to the organs, metastasizes, it becomes Stage 4 metastatic melanoma.  When the doctor told Mom, I could tell that she was in shock.  She didn't understand.  She had cancer.  She wasn't a smoker.  She only had skin cancer and had had some minor procedures to remove that from her nose and the top of her head (yes, under her hair!!!)  How could melanoma get into her body?

Not one to look at statistics, Mom, myself, and the nurse discussed treatment.  She was eligible for a new randomized study in which you could get a new drug, or the standard of care.  She was randomly assigned to the "old" drug, interferon, which included a year of drug therapy; one month of intensive IV therapy, followed by 11 months of three times a week self-injections.  We discussed everything that could happen to her body during the year of treatment.  She could get sick, feverish, unstable and lose her balance, and lose weight to name a few.  

During out meeting with the nurse, I mentioned two important things:
  • Mom needed to move her body (exercise) regularly to maintain her strength, and
  • Mom needed to eat healthy foods (green, leafy and colorful vegetables, fruits and plenty of protein, to fight disease and maintain muscles and good brain function over the course of a year.


The nurse quietly discouraged physical activity for the following reasons:
  •  Mom needed her energy to fight the disease (agree),
  •  Exercise would only tire her more (agree and disagree), and
  •  Mom's body should dictate what she could and couldn't do (agree and disagree).  
I think that Mom was actually relieved by the nurse's words, because she had never been a regular exerciser before, and this gave her a convenient excuse.  (Sorry to sound a bit harsh here.) In the end, the nurse's words won out over my gentle, yet insistent, reminders to "move your body".  I would urge her with every phone call to just get up and walk around for 5 or 10 minutes.  

Exercise can be the "magic pill", even for people going through cancer treatment:
  • With adequate naps (and nutrition), exercise in the appropriate doses can give you more energy to fight disease
  • With adequate naps (and nutrition), exercise in the appropriate doses can give you more energy
  • Yes, by all means, listen to your body, but don't succumb to it 100% of the time.  Sometimes, you just have to do it, because your mind may not be in a place to make good decisions
I just knew that a body left at rest for an entire year, would atrophy significantly, like a deep hole, and that climbing out of that hole could be difficult.  Difficult, but not impossible.

The Treatment

Fast forward several months and the interferon was taking a toll on Mom.  She was tired, ached, and was feverish within 12 hours of taking her doses.  The nurses and I urged her to be proactive on a course of Tylenol, so as to prevent and limit the side effects before they had a chance to set into her body.  When she took Tylenol, she was better.  When she did not, she was not as good.  It's one thing to know you should do something, and it's another thing to not do it.  Many people simply cannot take a pill if they don't feel awful, let alone take a pill as a precaution against something that doesn't exist at the time.  And so it went, month after month. 

But she didn't move.  Day after day, she would sit in her chair, watch the television, do crossword puzzles and sleep.   She was getting more tired and more weak with every week that passed.  Mom complained that she felt "weak in the knees" and sometimes her balance was "off".  (NOTE:  What Mom was describing was a general weakness in her quad /thigh muscles, which in turn, made her knees feel loose and wobbly.)  She got winded walking to her mailbox.  Half way through her treatment, I talked to the nurse, asking if Mom could get a prescription for physical therapy so she could begin the process of rebuilding her stamina and leg and core strength.  Her doctor wrote her the prescription and she did about eight sessions with a physical therapist.  She did all the exercises I knew would improve her quad strength (sit to stand, leg extensions, heel lifts, mini squats, and marching).  She did all the exercises I knew would improve her core strength (pelvic tilts and bridges).  When Mom came to visit in July, I asked if she was doing her exercises regularly.  She replied that she really wasn't.  (To everyone out there that has gone through physical therapy, you all know that when you are "discharged", you are supposed to continue your exercises on your own so you continue to maintain and/or build strength.) But, Mom was tired.  She wasn't motivated.  She continued to sit in her chair, watch the television and do her crossword puzzles.

Where We're At Today

It's been exactly one year since Mom started her treatment.  She will be done treatment this week and as of today, she is cancer free!  Her goal was to get through this year of treatment and be cancer free and she has reached her goal.  We couldn't be happier. I can hear the spark of energy in her voice again as she knows she is at the end of this journey.  This drug took a toll on her physically.  I think there is some memory loss, almost as if she was living this year behind a veil of "fog".  Memory loss may not be the right word.  Her ability to concentrate long enough to do simple tasks was compromised. Thank goodness she kept doing her Sudoku and crossword puzzles as a means of keeping her mind sharp.  She took naps when she needed them, probably as much as a means of "escaping" this year of living hell as anything else.

Physically, we have some rebuilding to do.  As the interferon leaves her body, we are anxious to find out if her energy will pick up immediately, or if it will happen over time. We are anxious to start on a program of rebuilding stamina and better health through better living.

As such, I have dedicated this weeks Free Workout Friday to Mom:  Fresh Off The Couch Part 1 for Stamina.  For someone whose muscles have atrophied over the course of a year, and whose stamina and endurance are severely diminished, I recommend the training principle of FREQUENCY.  At this stage of rebuilding, it is more important for someone to get up and get moving more frequently, which is why this program starts with moving your body a minimum of 3x/day for 5 minutes.

Tomorrow's blog is about Mom's struggle with Cancer and Food.

Here's to Getting Off the  Couch,

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