Anne Harrington, author of The Cure Within, A History of Mind-Body Medicine, emphasizes that mind-body medicine is a deeply storied world, and that stories told by scientists, doctors, patients, and ordinary people belong to all of us: "Their persistence (stories) in our culture reminds us that people have to make sense of suffering, and that illness and healing are not just biological but ultimately human experiences." Laura Pruitt, M.S., ATC, LAT, has offered to share her story so we can understand more about cancer from the perspective of a health and fitness professional. What follows is Laura's story, framed with questions that she responds to in her own words.
HOW HAS CANCER AFFECTED YOUR LIFE?
There is not one facet of my life, my family's life, my friends' lives, and many acquaintances' lives that it has not affected. This is a life-altering diagnosis that changes the lives of so many forever. Friends and clients told me I was (am) the healthiest person they knew. I did all the right things. Exercised, ate right, etc. Yet, I was the one who got cancer. At first, I felt as if I had let everyone down. Three months later, it was determined that this was a genetic expression. The doctors told me most likely I delayed the onset of the cancer by 10 to 15 years by doing all the right stuff (I was having children 10-15 years ago). I decided to apply the healing experience as a means to educate, as well as inspire others. I want others to know that no matter what obstacles they face, they can turn the obstacles into opportunities. Cancer taught me to not take things for granted, to try to appreciate everything more, including my children, my family, and my friends. I now understand that even the mundane things in life are important.
My husband, David, and our children have been faced with the realization that mom is not indestructible. This is a disease that kills people, but they also know mom is strong, mom is a fighter, and mom will overcome this. My husband has always been there for me but recently has had to fill in when I didn't feel well enough to function due to my surgery or chemotherapy. My boys, Dustin (age, 14 years) and Alex (age, 10 years), have had to grow up quickly. On the days that I didn't feel well, they did laundry, made their own meals, and got along.
Friends and acquaintances have rallied behind me and my family, stepping up to make meals, drive the kids to activities, and to provide moral support. As a result of my diagnosis, many friends have decided to take responsibility by having mammograms and checkups. The reality check for all of them is that if I could get cancer, then they certainly could get it as well.
WHAT ROLE HAS PHYSICAL ACTIVITY PLAYED IN YOUR RECOVERY?
Throughout my whole life, exercise was as important as eating, sleeping, and breathing. For 6 days, I was lying and walking around only in my house. My muscles were sore, I felt sluggish, and I felt like I needed to move. I believed that my body was going into withdrawal from not exercising. Six days after my double mastectomy, I slept, ate, and started light exercise. Once I started light exercise, I immediately started feeling better.
Seven days after surgery, I worked out on the elliptical trainer and completed a total of an hour of movement with my legs. I broke the hour up into three 20-minute sessions, with a little bit of lower-body strength training in-between. I made sure that as soon as I started to sweat, I would slow down the elliptical and back my heart rate down. My maximum heart rate was 185 (before surgery), I used to work out between 155 to 165, and push intervals to 178; now, I didn't allow my heart rate to go above 135. I didn't want to increase blood flow to the chest area because it would cause more fluid and more drainage.
Ten days after surgery, I was healing up fantastically. I was off pain medications, except for Tylenol® during the day. The wounds had stopped producing fluid and were healed. I increased my workouts to 70% of max heart rate reserve (Karvonen method) for 40 to 60 minutes with different cardio workouts every day, mainly spinning bike and elliptical.
During this time, I created strength training workouts for myself. I divided workouts into lower body one day, upper body the next, and initially spent 20 minutes for each workout. Some exercises included leg extensions, leg curls, one-leg sits/squats (holding light free weights 10-15 lbs). On the floor, lying on my back, I used a stability ball to perform hamstring curls, lifting my gluteals slightly off the floor, closed chain heels on ball, legs straight press down on ball with heel, and roll it on ground toward my butt by bending knees, hips off the ground. Laying down half abdominal curls curling the stability ball with legs. With the stability ball again, I would hold under bent legs, lying on floor on back, bring ball up off floor.
One month after surgery, I progressed my exercises. At this time, I was able to incorporate chest presses with free weights and cable crossovers at about 50% of my presurgery resistance levels (one set, 15 reps, 10-lb chest press, three times per week). By this time, I also was running 75% of presurgery speed, 5 to 6 miles in 42 to 52 minutes 2 days per week. My upper-body range of motion (ROM) was about 70% of presurgery as well.
Five weeks after surgery, my leg press, leg extension, and lunges were 90% to 100% of presurgery levels. I used tubing quite a bit for my upper body to increase strength, without increasing risk injury.
Once I started chemotherapy, I continued working out, but have had to modify. Typically, the first 4 days after chemo are the roughest. Those days, I will do an easy elliptical workout (45 minutes to 1 hour; heart rate, 135-155) and some weight training or walk (60-90 minutes at a moderate pace; RPE, 6/10). It seems that chemo effects are cumulative. I noticed that it takes longer each time after successive treatments for my body to recover.
A few chemotherapy side effects that were not mentioned to me include frequent urination, averaging four to five times at night, and diarrhea on an intermittent basis. Due to my age, chemo has thrown me into menopause, so I get to deal with night sweats several times a night as well! This is especially a problem when running, and if I feel like I'll have a problem, I don't run that day. Other exercises do not seem to trigger it.
CAN YOU DESCRIBE ANY AH HA MOMENTS OR EXPERIENCES THAT ARE GOOD LESSONS?
Everything about this disease has been a lesson. I will try to highlight the most important ones.
- I've learned you have to allow friends and family to help you. No matter how independent you are, how much you think you can do for yourself, you have to allow them to help. Helping is as much for them as it is for you. Friends and family feel totally helpless when you go through this type of disease/treatment. It helps them psychologically to feel they are doing what little they can, and, obviously, it helps you too.
- I've learned that the competitive drive of being an athlete helps fight this disease, and the fitness level that I had going into this disease has helped tremendously in recovery from surgery as well as my response to the chemotherapy treatments. On the other hand, I've had to reason with my competitive drive many times giving myself a break because I couldn't run the entire 5 to 6 miles or push my anaerobic threshold up to previous levels. It sometimes is a mind game that I play with myself because as an athlete, you are always driving your body through fatigue, but when you are fighting the cancer and dealing with the chemo, you have to refocus on allowing your body to stay strong to fight by not breaking it down.
- Chemotherapy was a learning experience. I received the Taxol (Red Devil) chemotherapy, which is supposed to be the most intense. I was told that the side effects would be rough: nausea, extreme fatigue, mouth sores, and hair loss. Yet, most side effects for me were mild, except for the fact that I did lose most of my hair. One of my biggest Ah Ha moments was the development of mouth sores. I have always been a healthy eater; however, I didn't eat many raw vegetables on a daily basis. Since I had the surgery, I have made it a point to eat raw vegetables daily, drink lots of water, and avoid alcohol. I try to keep my body as "alkaline" as possible. After my fourth chemotherapy, we took a short family vacation, and I broke away from my recovery eating routine for 4 days. I wasn't eating badly, but I neglected to eat raw vegetables, reduced my normal water intake, and drank some alcohol daily. By the third day, I had mouth sores for the first time! When we returned home, I immediately started back on my diet, and by the next day, 90% of the mouth sores were gone, and by day 3, all of the sores had healed! This proved to me that diet plays a huge role in the body's reaction to chemotherapy.
WHAT IS THE MOST IMPORTANT LESSON YOU LEARNED?
The most important lesson that I can share with others is that all females are at risk for breast cancer simply because we are female. Eating right and exercising are not gold passes preventing us from getting this disease! What these things will do, however, is help tremendously if we have to fight the disease. All of us need to get regular mammograms starting at age 40 years. Also, if there is any concern with the mammogram or any change in lumps, bumps, or shape, we need to insist on an ultrasound. I had two different types of cancer. If I had not had the cancer on my right side show up on the mammogram, I would have never known I had the cancer on my left because it's a type that does not show up on mammograms. Most likely, I had the bump on my left side for 1 to 2 years before it was discovered.
WHAT WOULD YOU LIKE TO SAY TO SOMEONE ELSE IN A SIMILAR POSITION?
Besides the points I've covered, I would say that everyone reacts to the surgery and treatments differently. Listen to your own body, and do what is best for you.
HOW CAN FITNESS PROFESSIONALS HELP CLIENTS?
We have to remember that everyone reacts differently to the surgery and chemotherapy. Surgeries vary, and there are different types of chemo treatment, with some more severe than others.
Once fitness professionals have medical clearance from the surgeon, we can begin to shape a program with the client. Range-of-motion development is critical for pacing the exercise progression. For example, begin with ROM exercises for the upper body and arms.
When ready, start lower-body exercises that include strength training, walking, stationary biking, and elliptical training. Include lower-body stretching to improve ROM. Include pelvic tilts to improve core strength. Core muscles may be weak from surgery and disuse during recovery.
When clients return to about 70% of the ROM from presurgery, light resistance exercises using tubing and bands may be a safe and effective choice to both strengthen and stretch.
As ROM improves, we can start using light weights and progress from there to a machine to more reps and heavier weights. I found that some of the last exercises that I could perform after surgery were upper-body flies, push-ups, and triceps dips.
Encourage clients to listen to their bodies. On the days after chemo, the client might need complete rest, but stretching might feel good. Or your client may need to walk instead of run.
THE STORY CONTINUES
I plan to continue with the program that I've been doing my whole life. I doubt I'll change. Remember, no female is immune from this disease (see sidebar on Cancer Snapshot). Also, a positive attitude is crucial, along with knowledge. Encourage your client (or yourself) to become a partner in treatment, not a bystander. Work to strengthen your client's resilience to help shape his or her life with proper exercise, healthy eating, and a positive attitude!
In December, nearly one year to the date of her diagnosis, Laura was pronounced cancer-free! She has been selected as a Power in Pink representative for Underarmour (http://www.underarmour/powerinpink) and was recently invited to give a keynote for The Relay for Life event in Cincinnati, OH.
Laura has documented her progress and workouts. If you are interested, please contact Laura at [email protected] for information.
To view Laura's television interview with Fox19, please visit http://bit.ly/Pruitt_TV_Interview.