Chemo Brain

Hallelujah, cancer survivors, if you’ve been suffering from “chemo brain” there’s new evidence that it isn’t “all in your head.” The results of a recent study, concluded that chemotherapy may cause “neurotoxic brain injury,” resulting in that muddled, foggy and forgetful state of mind that many cancer survivors have complained about. The same study stated that “chemo brain” may continue for up to five or more years after treatment.
Karen L. Syrjala, co-director of the Survivorship Program at Fred Hutchinson, stated “It’s clearly established now that chemo brain does exist and can continue long-term.” She also stated that information processing, multitasking and executive function skills all seemed to recover within five years.

Here’s a link to Well.blogs.nytimes written by Tara Parker-Poe if you’re interested in reading more.

http://well.blogs.nytimes.com/2011/05/04/chemo-brain-may-last-5-years-or-more/

This is a link to a summary of the study.

http://archneur.ama-assn.org/cgi/content/abstract/68/11/1447

When Not To Exercise

There will be times when it’s not advisable to exercise.  The American College of Sports Medicine (ACSM) and  the American Cancer Society (ACS) have developed
guidelines to help you determine if you should stretch instead of participating
in more vigorous activity. Don’t use these as an excuse NOT to exercise, just use common sense.

Stop Exercising If You Have:

• Chest pain or pressure
• Develop and irregular pulse of palpitations
• A  resting pulse higher than 100 beats per minute
• Decreased heart rate of blood pressure during increased activity
• Excessive rise in blood pressure
• Recurring leg pain or cramps
• Sudden shortness of breath, muscular weakness or tiredness
• Sudden onset of nausea
• Blurred vision, dizziness, faintness or light headiness
• Vomiting or diarrhea within the previous 24 to 36 hours
• Disorientation or confusion
• Pallor (paleness) or cyanosis (bluish skin)
• Fever
• Excessive fatigue
• Chronic muscle soreness that interferes with activities of daily living
• Bruises or swelling – may be a sign that a bacterial or viral infection is not healing or a sign the lymph system is not working

Treatment, Lab Values or Blood Cell Counts (from your doctor):

• High-dose intravenous (IV) chemotherapy within previous 24 hours
• Platelet count below 50,000/mm3
• White blood cell count below 3,000/mm# absolute granulocyte count below 2,500/mm3

Additional Precautions:

• Reduce exercise intensity in hot or humid environments or above 5000 ft
• Avoid exercise when you experience tenderness in a joint that worsens with activity
• Avoid strenuous aerobic activity during viral infections such as the flu or an upper respiratory tract infection
• Limit or eliminate upper body strengthening if you have a port, PICC or central line
• Avoid public gyms if you are within one year of a transplant
• Avoid pools with chlorine if undergoing radiation

Peripheral Neuropathy and Exercise

Peripheral neuropathy can occur during or after treatment for cancer. The numbness and pain from the damaged nerves can affect your balance and coordination making exercise more challenging. If your symptoms are severe, consult with your oncology team to determine if a referral to a physical therapist would be your first step in becoming more active.  The good news, research is finding that exercise can help to reduce your pain and increase your range of motion.

Exercising on a recumbent bike may be a better option than walking outside on uneven surfaces if you are experiencing balance problems. Avoid high-impact, repetitive exercises, such as jogging or step aerobics, as those activities could lead to fractures in the feet. You might experience some challenges in a resistance program due to pain from holding weights. Remember, you don’t want to have a “white knuckle” grip on the weights, just hold them firmly.  You can always pad the dumbbells by  wrapping a wash cloth around the middle to increase the diameter of the shaft.

The American College of Sports Medicine (ACSM) and the American Cancer Society (ACS) recommend 30 minutes, 5 times a week of moderate exercise, or 30 minutes of vigorous exercise 3 times a week.  If you are experiencing fatigue from treatment, break up your exercise into 10 or 15 minute segments and spread it out during the day.  You’ll want three days a week of cardio exercise and 2 days a week of resistance exercise.  It’s important to rest for 1 or 2  days between your resistance workouts.   When putting together a resistance workout, strive for a minimum of 1 set of 10-15 repetitions for each major muscle group,  i.e., back, chest, legs, shoulders, arms, core. Stretch out after each workout. Keep in mind, if you have a port, catheter, or PICC line you should avoid resistance work for that muscle. For example, if the port is in the chest, eliminate the chest work (chest fly or chest press). Of course, you can do the exercise on the side not affected by the port.

How To Achieve Your Exercise Goals

Successful businesses have a business plan.  In order to  success in adding exercise to your life, you will need an exercise plan.   I know, sitting down to write a plan may appear as insurmountable as beginning to exercise, but it’s important.

1 - Set a Goal
Do you want to have more energy,  play with your grandchildren, garden,  prevent a re-occurrence of your illness?  These are all reasonable and obtainable goals.  Write your goals down.

2 - How Much Time Can You Commit To A Exercise Program
10 minutes a day, 30 minutes, two 10 minute segments?  If you’re in treatment your fatigue levels may vary from day-to-day so give yourself some flexibility when setting this goal.  On days your fatigue is greatest plan for a 5 minute walk in the morning and a 5 minute walk in the afternoon.  On days  your energy levels are high try to achieve 20 to 30  minutes of  exercise.

3 – Keep A Log
You’ll want to record what you did, how long, and how you felt during and after your workout. Why should you do this?  To see your improvement.  The best feedback you’ll receive is this written record of your success.  A log also helps you pinpoint why on some days you  could be less energetic or motivated.

4 – Make A Contract With Yourself
Create a contract committing to 12 weeks of exercise, outline your program, include what  you will do if you hit an obstacle, and, how will you reward yourself at the end of the contract period.

Once the contract period is over reassess how you did, how you felt, and how you are going to keep exercise in your life.

How Should A Breast Cancer Survivor Begin A Resistance Program?

First, check with your oncology team and then begin slowly.  Even if you were active before your diagnosis and treatment, begin slowly.  Start with light weights, 8-12 repetitions with  one set of each exercise to cover the major muscle groups.

But, before I go any further, perhaps I should define some terms for you.

• Reps – a single cycle of lifting a weight.  For example, in a biceps curl, each time your bring your hand toward your shoulder and then return it to your side you will have completed one rep.
• Set – the number of reps you’ve done of one exercise. So, if you complete 12 reps you will have completed one set.
• Major Muscles Groups – The muscles of your core, back, hips, legs, chest, arms, and shoulders.

For those who have had lymph node damage, or lymph node removal, you will want to give your body 2 days of rest between workouts.  I would also suggest planning your workout to alternate one exercise for the upper body and one for the lower body.  That way you’ll limit  repetitive movement.  For example, 1 set of squats, followed by 1 set of back rows. It’s a good idea to have your arm measured before you begin the program.  That way, if you have any changes in the arm you’ll have those baseline measurements to work with.   NOTE:  If you experience swelling, heaviness or redness, contact your oncology team.

If you have a port,  picc or central line in the chest area you’ll avoid using a weight when doing your chest work.  That doesn’t mean letting your arm just “hang around,’ you’ll go through the range of motion on that side while performing the resistance work with your weight on the other side.

When you feel that one set of 12 reps is easy — you could perform more reps — then go ahead and add a second set.  When that second set becomes simple, increase the weight by approximately 5% and try one set of 12 reps at the new weight.

HYDRATE!

Plan on performing your resistance workout 2 times a week with at least 2 daysof rest  in between.  If you have any questions, contact me.

Why Do I Have To Hydrate?

Remember the dialogue in “Good Morning Vietnam” about the heat? The US soldier’s are so hot they are ”crotch pot cooking? Well, if you’ve  experienced the heat in the US this past summer that movie line may have come to mind once or twice.

As a cancer survivor hydration becomes critical. Being hydrated means the urinary system is staying healthy, eliminating toxins and bacteria. If those are not removed you are at an increased risk of developing an infection. Since many treatments compromise the immune system, any infection is dangerous. Lack of adequate hydrate can increase your fatigue and make you  lethargic. If you suffer from dry mouth or mouth sores staying hydrated  can decrease those symptoms. You will want to eat, your energy levels will remain high, and your body can concentrate on healing.

Water is not the only source of hydration.  You can get additional fluids from fruits,
fruit juices, smoothies and popsicles.  If  your nutritionist says it’s ok, moderate amounts of coffee and tea also aid in promoting hydration.  Don’t wait until you feel thirsty, get something to drink now!

Benefits of Fitness When Dealing With Cancer

David Haas has shared with me his perspective on the Benefits of Fitness When Dealing With Cancer.  You can view his comments at: http://haasblaag.blogspot.com/

Exercise has long been proven to be an important health component. It builds strength, endurance and helps to regulate appetite, sleep and mood. According to the National Cancer Institute, those who are suffering from cancer, whether it is breast cancer, melanoma or even a rare disease such as mesothelioma, could benefit from maintaining or starting a fitness routine.

Research shows that exercise can be effective in improving the quality of life of cancer patients. It can reduce fatigue and help the patient feel more energetic. The physical movement can help combat the weight gain associated with some forms of cancer treatment. It can also be effective at warding off the weight loss associated with other forms of treatment by stimulating the appetite. It increases bone strength, muscle strength and endurance, which makes it easier for the body to fight the disease and tolerate the side effects of treatment more easily.

Patients who exercise during treatment are stronger and fitter. They have more energy and are better rested. They are more likely to be at a healthy weight and be following a nutritious food plan. Exercise also improves depression and anxiety. This brings mental and emotional calmness and also clarity and strength. All of these things improve the patient’s chances of survival.

Maintaining a healthy lifestyle and fitness routine when in remission helps keep the body strong and reduces the chances of a relapse. Physical activity often helps people feel more in touch with their bodies. This may allow for a cancer survivor to notice changes in the way they feel, which can lead to early detection and treatment in the event of a reoccurrence.

Exercise can help you stay connected to the rest of the world. Enlist family, friends and neighbors to join your exercise plan. This way you can work on improving your level of fitness and avoid isolating yourself, a common behavior of those dealing with a serious illness. Check with cancer centers or support groups in your area. Many offer group fitness classes, such as yoga, walking groups or water aerobics.

Regardless of the specifics of your diagnosis, exercise can improve your quality of life and help you deal with your illness. Exercise can also increase your life expectancy if dealing with a terminal illness. There is no need to go to extreme measures. Walking at a normal pace for as little as three to five hours a week has been shown to be beneficial.

By: David Haas

You can contact David @ davdhaas@gmail.com

Lymphedema and Exercise

As recently as 5 years ago, if you had lymph nodes surgically removed or damaged by radiation, the advice you would have been given would be not to lift more than 5 pounds. Right, and WHO’S going to bring in the groceries? Fortunately that is no longer the case. Current research suggests that participation in a resistance program will not increase your likelihood of developing lymphedema.

• Before you begin any exercise program, check in with your medical team.
•  You will want to have a baseline arm measurement.  Measure between the elbow and wrist, and  between the elbow and shoulder.
• Begin with light weights and monitor your body’s reaction to the exercises.  Gradually increase the amount of resistance you use. What does this mean? Basically start with 1 or 2 pounds, monitor, listen to your body and slowly add more weight — possibly no more than 5 percent at a time — when the movements become too easy.
• If you currently have lymphedema it is advisable to wear a compression sleeve.
• If you have a port or picc line you will want to avoid resistance exercises in the muscles surrounding the port or picc line. But again, check with your medical team.

Endocrine System and Exercise

Made up of glands and organs, the endocrine system works to keep the body in homeostasis, or balance.  This system of ductless glands release hormones directly into the blood stream, sending these messenger cells throughout the body, continuously updating the body’s status to their target cells. Think of the endocrine system as a thermostat, it’s constantly making adjustments to keep your body in balance.

Pituitary Gland

The hypothalamus gland controls the pituitary, a marble-sized gland found at the base of the brain. During exercise the pituitary gland releases the human growth hormone.  This hormone tells the body to increase bone, muscle and tissue production.  The pituitary gland controls the thyroid and adrenal glands. Radiation treatment can cause hormone deficiencies.

Thyroid Gland

When you begin to exercise the thyroid gland, at the base of the neck, sends out hormones to regulate the body’s temperature, heart rate and blood pressure. The level of alertness and concentration necessary to work at an intense level also come from the thyroid gland hormones.

 Adrenal Glands

Located on top of the kidneys the adrenal glands are responsible for the release of cortisol into the blood stream. Cortisol levels control blood pressure, glucose and acts as an anti-inflammatory agent.  A second hormone released by the adrenal glands during exercise is aldosterone.  This hormone is responsible for regulating hydration, how much fluid is lost due to sweat.  Finally, during exercise the fight or flight hormone, adrenaline, is produced.  Adrenaline regulates the speed of the heart as well as the strength of its contractions and causes stored carbohydrates to rapidly turn over into energy.

Pancreas

Insulin and glucagon, hormones that control sugar levels in the body, are secreted by the pancreas. Exercise improves insulin sensitivity, reducing the reliance on insulin injections.

What does this mean for the cancer survivor? After radiation therapy you may experience isolated growth hormone deficiency, and will be at increased risk for hypothyroidism, thyroid nodules or thyroid cancer.  Some chemotherapy cause diabetes.   Hormonal therapy can cause sterility,testosterone deficiencies and premature menopause.

Fatigue

Fatigue during cancer treatment  is one of the most debilitating side effects a survivor experiences.  This kind of fatigue feels like a heavy weight on your body, and it isn’t relieved by rest. When you are experiencing  fatigue the last thing you want to do is exercise, but at this point, it’s  what your body needs most, movement.  Choose the time of day when you normally have the greatest amount of energy.  Walk to the end of the driveway and get the paper, pick up your mail, stretch.  Several minutes of movement will give you more energy.  I guarantee you will feel better.