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Wednesday Woes

Yesterday afternoon the knee situation took another bad turn. Just before leaving the house to see my afternoon clients I got a call from the orthopedics office informing me that my doctor has been "called into surgery" for Friday and has to reschedule. Their earliest appointment is next Thursday. I responded to this news as any rational adult would under the circumstances and began to cry right then and there on the phone. The woman calling was very nice about it and sympathetic but couldn't do much to help me.

They did arrange for my doctor to call in a prescription for painkillers.  We have plenty of those around here, left over from when I was going through the Taxol part of chemotherapy and from a tooth extraction I had (also during chemo), so I declined.

Here's where things stand now. I have the appointment with my usual doctor for next Thursday and an appointment at another practice about 15 minutes from here for Monday. This other practice is also supposed to call me right away if they have a cancellation today. We're having a snowstorm so I was optimistic that this would happen-so far no luck.

 I've finally given in and taken some Vicodin. This is a last ditch thing with me. I don't like how it makes me feel but at the point I'm at I seem to feel better with it (woozy, kind of out of it) than without it (like I'm going to flip out and throw some kind or pain/tension/stress tantrum). I also took an Advil which really I shouldn't take (burns holes in my stomach) but is what really works. I can get away with taking one occasionally as a last resort. If I could take something like this or aspirin regularly I would never get to where I am now. Oh well...

I've canceled my clients for the day, the fire's going in the woodstove, snow is falling steadily outside, the dogs are sleeping, and the plumber who arrived at 8 this morning is almost done fixing the pipes under our bathroom sink.

I've made a little nest for myself here on the loveseat by the woodstove- pillows, a down throw, some green tea, and a pile of books. The new books I have include, "Anti-Cancer: A New Way of Life," by David Servan-Schreiber, MD, PhD, which I bought myself as a birthday gift last month, and  "The China Study," by T. Colin Campbell and Thomas M. Campbell, a birthday/Christmas gift from Anna. Hopefully I'm not too Vicodin addled to read them. I'm also hoping to put together some recipes and meal plans for the next couple of weeks. I was thinking I might do some for Anna too, since she's also been overbusy and tired.

I find that the key to staying on track with my food and nutrition goals is to plan and organize meals and snacks ahead of time. When things get hectic, as they have been for the past couple of weeks, it's easy to find myself drifting into less than optimal eating behaviors; this can then lead to me worrying, which of course leads to more stress. Since I haven't been able to exercise at all for the past two weeks, staying on track with my eating is even more important than usual. I've been able to do a little bit of yoga and stretching, but that's about it. It will be so great to be able to walk again. In the meantime...

Exercise and Survival

Although you probably won't hear about it from your primary care provider or oncologist, exercise is one of the best things you can do to prevent cancer, including breast cancer. Even more interesting for women like me who have had cancer and are deemed (statistically) to be at high risk for it coming back, is that exercise may help prevent cancer recurrence, including metastatic recurrence. Recent studies have shown that regular exercise can lead to as much as a 50% reduction in recurrence rates for women who have been diagnosed with breast cancer. The most recent research has indicated that the INTENSITY of the exercise women engage in makes a difference in its effectiveness, with greater intensity resulting in greater benefit.

Although I am obviously not a good poster girl for advertising the cancer preventative benefits of regular, intense, exercise, statistically the evidence is there to support this argument. Regular exercisers have lower rates of a number of different cancers. Who's to say that I might not have been diagnosed with cancer earlier in life were it not for those years of regular running and biking? In my case the benefits of exercise were also confounded by regular wine consumption- a lifestyle behavior that my new, now more "cancer-smart," and wiser self, knows put me at significantly increased risk for developing a hormone fueled breast cancer (as well as all sorts of other cancers and health problems)- but that's for a future post.

Back to the present. Exercise is good, so good that it may be the most important thing I have done and can do in the interest of living as long as possible, maybe (if I'm lucky) even as long as my maternal grandparents who lived into their 90s. Vamos a ver...

Besides the possible utility exercise may have as a means of making one's life longer, it also, in my experience, offers the more immediately gratifying benefit of making one's life better. Exercise played a huge role in helping me get through my initial diagnosis and treatment. During those dark days last year as the process of determining the exact nature and degree of my misfortune was unfolding and it seemed for a while that at each level of exploration the answers seemed to get worse and worse, I couldn't do much to change what was happening- but I could walk- and that's exactly what I did- walked, and walked, and walked, and walked. I became the literal version of the saying about how when things are bad you just need to keep putting one foot in front of the other. I did the same thing during chemotherapy. Every day no matter how crappy and tired I felt I got out and walked at least 2 miles and sometimes as many as 5, depending to a large extent where I was in the treatment cycle and whether there was dexamethasone (a steroid drug with considerable "ramping up" effects, given in the few days after treatment to prevent nausea) involved. Thanks in part to this I got through chemotherapy without gaining any weight, in fact I lost a few pounds. This is also a big deal since weight gain during chemotherapy is very much the norm and is directly correlated to decreased likelihood of "disease free survival" (aka not dying at a later date from the cancer showing up later somewhere else in your body).

After finishing treatment last year (I had my last round of chemotherapy on October 6th 2007 and my last radiation treatment on December 19th 2007), I began working up to the more strenuous kinds of exercise I'd done in the past, mainly running and biking, but adding in swimming after a few months when my neighbor (now turned training partner) and I signed up to do the Danskin New England 2008 Triathlon. Doing the training and successfully completing the event provided me with a huge boost toward feeling healthy and more in control of my body again. I enjoyed it enough that I completed a second triathlon on September 14th, 2 days before having my second, this time prophylactic, mastectomy. Although my main reason for having the surgery was so that I wouldn't have to continue to have the remaining breast monitored or continue to have to deal with the uncertainty of a possible local recurrence hanging over me, I was also influenced by the side benefit that with no breasts instead of one I would be able look fairly normal, albeit a bit flat chested, wearing a regular athletic swim suit with no prosthesis.

Since the surgery I've been a little slow getting back into the routine of hard exercise on a regular basis. In addition to having to rest up a bit so I could heal I also had a variety of other things going on, not the least of which was opening my own independent practice and having to learn, on the fly, some of the skills of being a small business owner in addition to being a clinician. I was okay with this for a little while, the business and continuing to earn a living had to take priority temporarily. Now that that's a little more settled and things are becoming more routine I need to return to my main priority which is taking care of myself and doing all I can to live well and live long. Now that I am working only for myself I notice that time management is a real challenge and it is easy to put off exercise thinking that I will have time to do it later in the day because after all I make my own schedule. It really hasn't worked this way, especially now that it's dark out before 5:30 pm.

One of the great things about being a psychologist is that I have all sorts of knowledge that I can sometimes, when I'm being smart about it, apply to myself. This month I've decided to apply what I know about the benefits of setting clear goals, having a routine, and exercising early in the day, in order to get back on track. For this month I am going to exercise every morning first thing as part of my new morning routine- either getting out for at least a 30 minute speed walk, run/walk, or run. If more exercise happens later in the day that's great, "gravy" as they say, if not fine, I've gotten a workout in.

For those of you inclined to comment, especially women previously diagnosed with breast cancer, I am interested in hearing about ways that you have structured your life in ways that make it easier to take care of yourself, whether it's in the realm of exercise, diet, or other self care activities.