I took Wendy for a little walk last evening after dinner. On our way home I noticed a deer walking down the road towards us, stopping now and then to graze. I decided to stand still and see what would happen. Wendy cooperated by lying down next to my feet. The deer kept coming and basically walked right up to us. I don't know what the story is with the tag on its ear. Wendy stayed calm the whole time. I think she may have wondered why it didn't ask to play. Apologies for the poor photo quality. I took the photo with my iphone and it was dusk. It seemed worth sharing nevertheless.
I haven't really thought too much about the Baker's Cyst issue recently but I have noticed from the blog stats that a lot of people search the topic and end up reading my blog. I occurred to me that since my posts dropped off right after the knee issues that this might give people a negative impression of what might happen to them- death, paralysis, etc. This isn't the case so I decided that I should give a little knee update for you Baker's Cyst Google Searchers out there.
The knee is...okay... which is an improvement. The fluid from the ruptured cyst reabsorbed as it was supposed to, although for several months my left shoe(s) were always too tight- a little bit of swelling really affects shoe fit. I got some blisters because of this and also couldn't wear certain shoes at all. Now all my shoes fit fine. At this point the cyst is still there but in the last month it's finally gotten smaller, from golf ball size to not much of anything, just a slight bump behind the knee.
There is still room for improvement as far as knee function. The swelling is finally down, again, just recently. I can walk without pain and am starting (very slowly!) to do a little bit of strength training and recumbent bike. I've tried jogging but that has led to immediate increases in pain and a return of some swelling.
These results/problems are not typical from what I've heard. There's not a lot of data out there on this topic but it may well be that the aromatase inhibitor I take, Femara, and also the Zometa I've received once and will be getting again in December, have had an impact on my joint health and healing. Again, there's not a lot of info out there on the impact of some of these breast cancer treatments and orthopedic issues, but these drugs do affect the bones and joints so it seems plausible.
It's been good to get back to regular exercise, even if it's just walking. I don't know at this point if there will be anymore running in my future. Biking I'm more optimistic about It's not really a big deal since I'm not exactly an elite athlete. As long as I can get a decent amount of exercise in some form and as long as I'm not in pain all the time I'm happy.
As you might guess from this post title the knee is doing much better. I saw the orthopedist yesterday and had the stitches out. He was pretty satisfied with how the knee is coming along, although he does think that at least a couple of physical therapy sessions would be helpful. I'm having a little more difficulty, compared to what most people experience after this type of surgery, straightening the leg. He said I can do a couple of sessions and then evaluate whether to just do whatever exercises/program they give me on my own or whether it would be better to keep going for a full course of 10-12 sessions.
The most satisfying part of the visit was having him go over what he'd done and getting his opinion that going back to running (slowly after building up with a walking, then jogging program, plus the rehab) at any level I choose to should be no problem. Crystal and I are signed up for our second Danskin Triathlon (end of July). I'm confident that I'll be able to do it.
Patches and I celebrated this good news and kicked off triathlon training yesterday with two 15 minute walks up and down our closest dirt road. This morning we were really ambitious and walked a full two mile loop. Now we're reaping the benefits- Patches is asleep on the couch and I just feel BETTER. Gus and Wendy had a walk too, but a shorter one, kicking off the start of their canine weight loss and fitness program- sorely needed after this past winter of not getting nearly enough walks, between the weather and my knee problems. It was so great to get out in the sun and enjoy the signs of spring that are suddenly showing themselves everywhere- sprouts of green coming up on the roadsides, budding trees, ducks on the ponds. Today we saw mergansers- can't remember if they were the hooded or common. Yesterday on one of our walks we saw two piliated woodpeckers. For more on our local birds see Crystal's blog.
*I just checked Crystal's bird photos. It was the hooded mergansers we saw- on Rebecca and Michele's pond.
Today marks the 5th day since the meniscus and tibia cartilage trimming and I am finally turning the corner. The shower prohibition ended this morning so in addition to feeling a little better (more on that in a minute) I am also clean. Showers are so taken for granted and under-appreciated for the luxury (both as a pleasure and as a major indulgence in terms of the resources they use) that they really are. I saved a lot of water this week with my washcloth baths and the one hair washing I did at the kitchen sink. It dawned on me, during this at the sink shampooing, that when I was growing up people used to often wash their hair at the kitchen sink. I don't think people do this anymore. I wonder why?
For the most part I've spent the day lying down with my leg up with the calf well wrapped. The wrap makes a huge difference in cutting down on the pain. The rest and elevation seems to have worked its magic. Suddenly this afternoon, for the first time since even before the surgery, I found that I was able to walk without a limp. This was pretty exciting since the whole point of doing all this was to have a functional knee again. Although I'm still not up to spending a lot of time on my feet, I finally feel like I'm headed in the right direction. My plan is to keep doing what I'm doing, with more walking added in as I can tolerate it. I'm still tired- like really wiped out tired- from the systemic impact of being put to sleep and having power tools used inside a major joint. Although the holes they make are really little this stuff takes its toll. Hopefully the recovery process will start to speed up over the next couple of days. I have to teach Tuesday night and it will be little tough doing it if I don't feel a lot better than I do now.
Jim is making dinner again, another soup, this time with potatoes from the Brookfield Farm. This weekend is the last winter share pick-up. We'll have to go tomorrow or we'll be out of luck. It won't be long until the Foodbank Farm opens for the season and we'll start seeing all those greens again.
The dogs continue to get along. Patches is a joy and a nuisance- smart, sweet, and fun, but also good at finding trouble and finding it fast. She's so big and so agile that she can overcome almost any barrier. Put up a gate and she just leaps over it. If she wants something on a counter, say a stick of butter, she can just help herself. Just now while Jim was cooking she got one of my sweaters, luckily an old one, and chewed part of the collar off. Once I'm back on my feet there's going to be some serious dog proofing around here. Good thing she's crate trained or we'd really be in trouble.
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.
If you could see through the trees across this beaver pond you'd be able to see our house. Taking this photo I was struck by the overall lack of vibrant color. It was the same last year. I had the dogs with me and it was tricky to take this without having Wendy walk into the poison ivy that's growing all over the sides of the road. Gus is more cooperative, being naturally obedient and now aged on top of this. In spite of his being well and in many ways still puppy-like, Gus has been showing his age more and more over the last few months, so all our walks together are short now. He likes to walk and still prances and jumps when he sees his leash, but once on the walk he's pokey, while Wendy pulls ahead unless I keep laying down the law with her. The whole thing can become a pain rather than being a pleasure like it used to be. Keeping it short helps. If I want a long walk I go without them. It seems a shame but I've had to get over it.
Sometimes walking is just walking but sometimes it's what I do to save myself when it feels like there's no place else to turn. When I was first diagnosed with breast cancer last year it was what I did to get through those early worst days when I would wake up in the morning and remember I had cancer instead of it just being a normal day the way it used to be. I walked when I was going crazy from anxiety while waiting over a long weekend for the results of my staging tests. If you walk long enough it seems things become more manageable. I also had this kind of superstitious or magical notion that if I just kept moving forward-walking, on the bike, whatever- that I wouldn't die. I still semi-believe this even though I know no one has ever attained immortality by this method- a lot have died with their boots on I bet, and were probably better for it. It is interesting and encouraging to hear that exercise can decrease recurrence by as much as 50%. Makes me wonder if there is an intuitive aspect to my superstition.