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.

Mental Clutter

Perhaps I have no business writing about clutter, because I am a clutterer. I’m clean. You won’t stick to any surface in our home, but you may have to move some magazines to find a spot for your glass on the coffee table.

Sometimes My Surgical Mask Feels Like a Gag by jparadisi

Sometimes My Surgical Mask Feels Like a Gag by jparadisi

The topic of clutter is larger than that unwieldy pile of unopened mail on the dining room table. In the words of Newman, the mentally unbalanced postal worker on Seinfeld, “The mail never stops. It just keeps coming.”

The relentless flood of mail is not unlike the emotional barrage facing nurses during a typical shift. The tragic diagnosis of a new patient, recurring cancer in a well-known patient, too many patients, not enough nurses, phones constantly ringing, and unfamiliar chemotherapy regimens are just part of it. Then there’s the work environment: difficult coworkers, budget cuts, and, oh, no time for lunch today. At times, it’s overwhelming.

These things create a work day mental clutter difficult to shed at the end of a shift. Mental clutter paralyzes creativity, interferes with relationships, and impedes sleep. Managing stress is essential to happiness.

Having a mental clutter shut-off switch between work and home is effective. A mental clutter shut-off switch is a ritual activity, which when performed, tells your brain that:

  1.  The shift is over.
  2. You are going home.
  3.  You are leaving the workday craziness at work.

Easier said than done, but it can be done. Don’t we teach patients methods for managing stress?

Here are ideas for creating a mental clutter shut-off switch between work and home:

  • Join a gym or yoga class near work, and avoid rush-hour traffic by exercising before driving home.
  • When driving home, turn off the car radio. Listen to soothing CDs or a book on CD, such as God On A Harley by Joan Brady. It’s the story of a nurse learning to simplify her life.
  • As soon as you get home, take a 20-minute walk. Put your walking clothes and shoes on your bed before you leave for work, so they’re ready and waiting for you.
  • Create a personal sanctuary in your home. Mine is a comfortable chair with an ottoman. Next to it are my laptop, paper, pens, a sketchpad, knitting supplies, reading glasses, and several books. A small table holds a cup of coffee or tea.
  • Limit discussions at home about work to 30 minutes. Set a timer if you have to, and then stop when time is up.
  • Limit your time watching the evening news. Avoid it before bedtime. Be informed, but remember that you can’t fix the world.

That brings me to my last point: You deliver the best care reasonably possible to your patients, but you are not responsible for their outcome. You are a nurse, not a superhero.

What would you add to this list?