Breast Cancer Issues: Physical Activity During Treatment

The following post is the second of a series resulting from preparations for a forthcoming breast cancer conference panel discussion on survivorship.

by jparadisi 2012

by jparadisi 2012

When I was diagnosed with breast cancer I was a pediatric intensive care nurse working twelve-hour shifts, a long-distance runner, practiced weight-training, and a gardener. After the diagnosis, these activities came to an abrupt halt. Surgical procedures meant no running for weeks at a time. Weight training was limited by restrictions. Chemotherapy meant avoiding infectious patients, let alone managing critically ill children with my chemo-brain. Gardening was okay, but only so long as I didn’t get cuts or wounds that could become infected due to a lowered WBC.

Surrendering an active lifestyle in exchange for the other side of the bed was not an easy adjustment, and I held out for as long as possible. During treatment I didn’t have the energy to participate in these activities to the same levels as before. I continued running after my first chemotherapy infusion until one day I completed 1 1/2 miles and then completely bonked. I had to walk back home that 1 1/2 miles with bone deep fatigue. Grudgingly, I gave up running while on chemo.

For some, physical activity is a go-to method of stress relief. For many cancer patients, when this tool is needed most, it is unavailable.  It requires developing new tools for managing stress.

It’s important for nurses and health care providers who are not physically active to understand that a lack of physical activity actually creates stress for patients who are. It’s one reason your adolescent and young adult patients often become sullen. Physical activity is part of their mind-body connection.

The median age of breast cancer diagnosis is 61, so It follows that many hospital-based exercise classes for breast cancer survivors are structured with the intent of increasing physical activity and function for older, sedentary survivors. While beneficial, these classes may not meet the needs of the physically active, regardless of their age. Breast cancer patients who beg to continue swimming, running, bicycling, and even skiing are not uncommon. Here’s some exercise tips for physically active breast cancer patients:

  • Review your level of physical activity with your medical oncologist and surgeon before resuming or starting an exercise program. Surgery remains the cornerstone treatment for breast cancer, and physical restrictions apply post-operatively to promote healing. Mastectomy, reconstruction, and lumpectomies require different periods of recuperation. Some chemotherapy regimens used to fight specific types of breast cancer have potential to affect the heart. Those with metastatic disease may have other restrictions. Forgoing your activity of choice is difficult, but it’s important to remember that taking the time to heal is an investment in overall wellness.
  • Consider alternative forms of exercise. Walking is commonly prescribed during treatment. Meditation labyrinths are a great way to get some exercise and practice mindfulness at the same time. Some hospitals, spiritual centers, and churches have them. Ask about stair climbing-I used a Stair Master (once cleared by my surgeon), and did not have the energy to run outdoors. Running machines are another option: If you get tired, you can stop without having to get back home.
  •  If you are medically cleared to use a gym make sure to bring antibacterial wipes to wipe down the machines before use, if they’re not provided: If you are receiving chemotherapy, you are more prone to infections from opportunistic germs. If you take a yoga class, (another commonly recommended activity for breast cancer patients) bring your own mat, and wear plastic flip-flops to avoid fungal infections from the studio floors.
  • Remember, physical fitness is not what you do in the short-term, it’s an accumulation of activity throughout a lifetime. Going through breast cancer treatment tests your body; it’s working hard. Support its healing through good nutrition and adequate rest.

Can Nurses Change Course? Thoughts on Inertia

When I hear the word inertia, the meaning I think of is actually paralysis:

The loss of the ability to move (and sometimes to feel anything) in part or most of the body, typically as a result of

Take One Daily by jparadisi

Take One Daily by jparadisi

 

illness, poison, or injury; inability to act or function in a person, organization, or place.

The actual definition of inertia is:

A property of matter by which it continues in its existing state of rest or uniform motion in a straight line, unless that state is changed by an external force. Inertia is the inability to change course.

Nurses experience inertia when we are unable to switch gears from the high emotional output of our jobs to the more “normal” activities of our personal lives.

I wrote about my difficulty changing course in “The Hostess With The Mostest.” In that post, I describe struggling to transform from on-duty nurse into a party guest at the end of a shift. The difficulty is not only in physically changing from work clothes to party wear. It’s also in retooling my brain for party talk. I have to remember how to talk about favorite restaurants, or the latest film I have not yet seen, instead of cancer nursing, blogging about nursing, or the other related things I spend large amounts of my time doing, casting a shadow over a perfectly good cocktail party.

I think about this while observing people who are not nurses enjoying themselves by taking funny pictures with their cellphones while I avoid being caught in any photographs I wouldn’t want an employer to find on Facebook. Do I worry too much, or is it this a characteristic that makes me a nurse?

It’s healthy for nurses, like myself, to avoid inertia and change course through external activities after leaving our places of work. I find it easier said than done, however, not because I can’t relax, but because “normal” life sometimes fails to hold my attention.

I suspect other nurses find normal life less interesting than their nursing roles, too. If we aren’t over-scheduling ourselves with committee meetings, working overtime, all the while being the World’s Best Soccer Mom, we don’t feel busy enough.

This point was brought home to me by a friend who commented that I seemed tired after I said I was going for a run after getting off a 12-hour shift early. I told her, “No, I’m not tired. I only worked eight hours today.” She replied, “For most people, eight hours is a full day’s work. Go home and get some rest.”

I didn’t. I went for the run. I do my best thinking while running, not meditating on a yoga mat. It’s hard to walk when you’re born to run.

Do you think preferring a busy and sometimes-hectic lifestyle is a characteristic of nurses?

Baby, I Was Born to Run

Identity: Self Portrait

David and I are at our favorite brewery slurping steamer clams with broth-soaked crusty bread and sharing pints. Overhead, Bruce Springsteen’s disembodied voice wails Baby We Were Born to Run:

The highway’s jammed with broken heroes on a last chance power drive

Everybody’s out on the run tonight

but there’s no place left to hide

Together Wendy we can live with the sadness

I’ll love you with all the madness in my soul

h-Oh, Someday girl I don’t know when

we’re gonna get to that place

Where we really wanna go

and we’ll walk in the sun

But till then tramps like us

baby we were born to run

It’s the first hot, sunny day of the year in Portland, and I’m thinking life doesn’t get any better than this.

In a few more days, my medical leave ends and I return to work in the ambulatory oncology clinic. Damn, back to work just as I’m feeling good. That’s how it goes. I’m mostly ready. There are restrictions on lifting, and time on my feet, which require light duty for a couple more weeks. I will return the same week Epic, the electronic medical record (EMR) program, goes into effect. The way the medical leave program works at our hospital, I was restricted from attending Epic training classes while on leave.  I hope I’m allowed to make them up during the time I’m on light duty. Otherwise, I will hit the ground running along with my colleagues.

It’s okay, because baby, I was born to run. Literally. Running is my exercise of choice. I haven’t been able to since this health problem began. Running is as much a part of my morning routines as brushing my teeth. I don’t feel right without it. Hopefully, my surgeon will give the go ahead to start at the next follow up visit. I am cleared for walking and do at least a short one most days. Growing stronger, and healthy again, I feel energy building within me.

The need to run is not only physical. It’s mental too. I miss my nursing job. I miss being the person who helps instead of the person needing help. I want to be Superman, not Lois Lane. I want to drive the motorcycle, not hold on from the back seat.