In the previous articles in this series, we've journeyed from diagnosis to testing, surgery, chemo, radiation and now……we're onto life. How do you go onward from survivorship to thrivorship?
If you have had lymphatic challenges, remember that any exercise or exertion requires that you wear your pressure garments. It's important not to push the lymph vessels beyond their comfort level, so don't let yourself overheat. Remember to protect your skin (and the lymphatic vessels who live just under your skin) from sun, bug bites, scratches and hot tubs/steam rooms. When you're exercising, choose loose and comfortable clothing and make sure you never have a bra line visible on your skin when you take it off! "No restrictions" is the rule, so check your skin. The sensation around your bra line may be reduced from surgery, so check in a mirror. Always keep mindful of your "daily arm load", never pushing past today's budget. And keep your energy tank at least ¼ full.
Breathing is natural, right? You take 23,000 breaths per day. Some of your respiratory muscles have been interrupted by surgery and furthermore by radiation. Learning to breathe in varied ways, fully and completely can be helpful. How you breathe, how your ribs and 3 diaphragms (your throat, breathing and pelvic diaphragms) move is an intricate ballet. Asking your physio or yoga therapist/teacher to help you learn to breathe well again is wonderful!
Shoulder and arm movement is a focus during your post-surgical time. The muscles that both guide and move the shoulder are on your chest and back. You'll need some nudges to learn to find, time and strengthen the shoulder (the spine, shoulder blade, collarbone and shoulder joint). Keep in mind that your body wants to restore to beautiful movement and function.
Pelvic function (bladder, bowel, sexual, pelvic organ support) may need some attention through this time. The posture that you may find comfortable after surgery (leaning forward + curling inward) puts pressure on your pelvis. Some of the hormonal therapies reduce estrogen's lovely bouncy support of the pelvic systems. If you're struggling with pelvic function, ask a pelvic certified physiotherapist to assess you and help you along. It usually only requires a few appointments.
Are you taking time for restoration? In really big studies, 30-90% of women report loss of sleep through the first year of breast cancer. You need sleep for recovery, sleep to reduce "chemo brain", sleep to support's brain's own lymphatic (called the glymphatic) system, sleep to help your body heal and sleep to help you find the "new you". Practice consistent, sleep-supporting strategies and rest before you're exhausted. Daily calming practices may also reduce any pain you may be experiencing by reducing the general threat level under which your body is living. Know your limits and respect that your body may be on high alert. Practice deeply compassionate self care. Meditate or pray for 10 - 15 minutes per day, sitting quietly and listen to your breath. Think back on all you've been through and the resilience that you've discovered. Be open and vulnerable with your MIPs (most important people), ask for understanding and help when you need to, find peace with downtime and rest….these are new skills for many of us. Play a little and enjoy today.
Women with breast cancer have undergone surgery, experienced radiation and/or chemotherapy, then have begun hormonal therapy. Reconstruction surgery may be a next step.
How do you press restart button with this new body, new awareness, new priorities?
How to you go from survive to thrive?
We'll begin by looking at exercise in all its forms. Exercise is a key part of survivorship, reducing recurrence of breast cancer by 50% thereby boosting thrivorship, that brilliant skill of learning to live a joyful life again! A key to remember is that breast cancer survival rates, since 2010, have grown beautifully. It is now considered a chronic disease, different from diabetes and arthritis for sure, but breast cancer is a disease to live with and manage.
Research has shown that strength training is key. It must be wisely employed in order to avoid overwhelming Cancer Related Fatigue (CRF), to respect the surgical/structural changes in your body and posture and to help stave off lymphedema. While you're undergoing chemotherapy, we know that better oxygenation from strength training improves the therapy's effect, so it's good to exercise gently and consistently while undergoing chemo treatment. However, with radiation it's a time to maintain and not gain; you'll be working at holding your own through that time.
Strength training is two simple words, but do you have to go to a gym when you may be immune-compromised and overwhelmed with social interaction? No. You can do this all at home with a structured programme, some knowledge about the how-to's and some awareness around wise limitations. The first words to repeat are start low, progress slow. Learn how to strengthen your dorsal self (think dorsal fin) that has become long and weak. Learn how to stretch (gently, carefully and consistently) your front body where all the attention, surgery and radiation took place. Learn how to build your bone health again through weight bearing activities and exercises.
Your bones have been challenged by reduced activity while you went through medical/surgical interventions and rested, age/stage (menopause reduces your estrogen which is a bone-protective hormone), chemotherapy (which may have reduced your estrogen even more), radiation (to your upper arm and mid spine), corticosteroids (for nausea and inflammation) and reduced nutrition because is was difficult to eat well through this time. Bone loss can be reversible. Improve your awareness of balance and intentional movement so that you are protected from a broken bone due to a fall. Attending to bone supporting exercises and balance challenging exercises can be simple and fun. You can use your body weight, a wall, the floor or your bed to perform all the exercises that you need.
In respect of CRF, remember that you must be aware always to only reduce your energy "tank" to ¼ full. Check in with yourself, stop at ¼ tank, respect your limitations and begin again tomorrow. If you have a week off for a holiday, illness or treatment, reduce the intensity when you take exercising up again. We talk about increasing your "exercise markers": cardio (huff and puff), strength, flexibility and endurance, remembering always that slow and steady is the key.
Overexercising can bring on overwhelming fatigue, stressful inflammation and put you at risk of lymphedema. Remember we want to keep lymphedema at Stage 0, practice an immediate response to cording or Axillary Web Syndrome and awareness of those almost imperceptible symptoms of lymphedema (tingling, heaviness, density or weightiness of an arm).
An amazing resource is the APP "Untire", offered free of charge online through your favourite app store from 2 Danish researchers. It helps you navigate whether to rest or be active, to support sleep and calm your body, to be social or pull inward.....great recommendation from many in the cancer world!