Language

Training in weightlifting I am surrounded by Crossfit athletes, who are beasts, badasses, fighters, killing or crushing the next WOD (=workout of the day), tackling the Hero workouts. And there is a myriad of abbreviations to get used to. I love the enthusiasm and zest of the Crossfitters, and the wonderful support and encouragement I have been receiving from them.

Before my diagnosis I had only been vaguely aware of the fighting language in the breast cancer world. The other day I received an invitation to a breast cancer survivorship celebration organized by a local health care clinic. Do I even qualify as a survivor? It has only been two months since surgery.  When can I call myself a survivor, if ever? There are fundraisers to fight the battle of breast cancer.  What can I fight? Is this a battle to be won?

These words seem to imply that after diagnosis, we go through treatments and then it is over. But it is not. Hormonal therapy continues for years. Complications can occur long after immediate treatments, e.g. lymphedema. Breast cancer can recur anytime and does, or it can metastasize. The best we can say is that we are in NED ("no evident disease"). Such language may also imply that somehow dealing with cancer is in our hands. Many women are affected by breast cancer who have various lifestyle situations or choices, vegetarians, meditators, exercise enthusiasts, healthy BMI, younger age. These are factors said to reduce the risk. There is no point to look back and wonder whether we could have done something different. Lifestyle choices  do not eliminate the risk, and should definitely not get in the way of seeking medical help.

Breast cancer awareness month is in October every year. There is a lot of commercialism with pink ribbons. What is it that we should really be aware of?

• Being aware that our bodies, that let us know faithfully when something is amiss, a sore throat or back pain, will not warn us about cancer in the breast. A self-exam or scheduled screening can identify a lump that does not hurt or feel foreign.  
• Being aware that there is an onslaught of information, uncertainty, confusion at the time of diagnosis. And it is good to be prepared for ourselves as well as for family and friends. How many women do we know with breast cancer? Look around, 1 in 8 women, there will be some in our circle of acquaintances. 
• Being aware that we have no inkling that a fun activity or exercise can result in swelling the next day. 
• Being aware what life is like during or after treatment: clothing, hair, changes in our bodies, and more. 
• Being aware that bad things happen even with positive thinking, as Barbara Ehrenreich so eloquently writes: Smile! You've got cancer

This has also been expressed by various bloggers, I'm living with cancer, not fighting a war or Breast Cancer Awareness? Let's get real or The pinking of America or in the book "How to be a friend to a friend who is sick" by Letty C Pogrebin.
And keep in mind  to check out charitable foundations before enthusiastically supporting an initiative, because it may be different from what you thought it was: http://www.charitynavigator.org

Changes

Some exercises feel different, such as lifting weight overhead and stabilizing. Perhaps this is due to a different weight distribution with the breast tissue removed. It may take some time for the muscles to relearn optimal movements. Very cool! Will this make the push-ups easier?

I like the breast-free feel. It is comfortable, especially in hot weather. People don't notice, unless they know about the mastectomy. Or they notice something, but don't know what, such as when I get a compliment how much weight I lost. Of course, I did! JJJ

However  I got a mastectomy bra and breast forms to use for special occasions or when I think I need props (e.g. some work events, but not all the time). I don't like bras unless they are super comfortable and I can breathe and expand my rib cage. I was thinking of going down one size, but smaller breast form sizes apparently do not go well with larger sized  bras (=the breathing requirement has priority). I tried it on at home. I had so gotten used to being breast-free in just 9 weeks post surgery that it feels like trying on high heels as a little kid. My loved ones don't care what I do as long as it works for me. They are keepers!

Weightlifting training 8 weeks postop

First time back with 2 hours weightlifting training 3 times per week. This is week 1 of a 7 week training plan to prepare for competitions.
I am very happy that it works, and much sooner than I had dared to hope.

According to plan this week is a high volume week with many repetitions and sets at a 60-80% level of the maximum weight lifted (prior to surgery).  While some of this is more than I had lifted post surgery so far, I was able to stay close to the prescribed percentages.
This includes snatches (up to 80% max), clean & jerk (up to 85% max).

WEEKLY SUMMARY
TOTAL Weightlifting training about 6 hours
TOTAL Cardio about 1 hour
TOTAL Core: (almost) daily Pilates with foam roller up to 2 hours, yoga class 2 hours
TOTAL Mindfulness practice:  Tai Chi 2 hours, Reiki meditation 6 hours

There is still fluid under the right arm, sometimes more, sometimes less. Less after weightlifting and stretching, more after push-up type exercises.

Do-it-yourself Reiki

A mindfulness practice reduces much stress and anxiety that arises with a breast cancer diagnosis, allows you  to sail through appointments and treatments, and helps you to better deal with hiccups that are sure to come. Best of all, you don't have to be anywhere specific, or have somebody else do it for you, you can do it yourself - anytime!

There are five elements of Reiki: Precepts, meditation practices, hands-on-healing, symbols and mantras, and reiju attunements. Much can be said about each of these elements. Healing starts with our heart and mind. This is embodied in the precepts that are a good starting point as well as an integral part of continued practice of Reiki:

For Today only
Do not anger
Do not worry
Be grateful
Be true to your way and your true self
Be compassionate to yourself and others

By contemplating each one, we can delve into what it really means. As we become more familiar it gets easier to recall these precepts at a moment when we become stressed to help us return to a more balanced state of mind.

More details, further references can be found here: chanting the precepts

There are excellent resources about the Japanese system of Reiki, e.g. http://www.ihreiki.com/.

I am very grateful to be able to continue studying with my teacher Frans Stiene. 

Tamoxifen fears

I felt on top of the world: recovery has been going well, back to almost full load of weightlifting training, feeling healthy and fit, stronger than before the mastectomy, taking more time for myself, possibly putting the breast cancer episode behind me. Maybe I already achieved with this blog what I wanted to do, documenting exercise that can be done post surgery.

There is no such thing as putting breast cancer behind us as many bloggers attest to when discussing survivorship. It stays with us and can recur. There is no way of knowing whether, or when, or how serious it can recur. The unpredictability is frustrating. What can we do? Good nutrition, exercise, keeping a healthy weight are all associated with reduced risk, but there is NO guarantee.  Women with healthy lifestyles get breast cancer.  Our bodies don't tell us. We cannot rely on signals from the body alone and must use our brains. For example, some exercises feel good at the time, but cause swelling later.

I got the prescription of tamoxifen filled. Side effects are mentioned on the pamphlet such as hot flushes being the most common.  While making decision after diagnosis I had searched breast cancer blogs and forums for input from other women athletes to get ideas about exercise post mastectomy, since the general recommendations are minimal. So now I wanted to do the same: looking to experiences with tamoxifen by women athletes  A sure way to freaking out! The positive frame of mind and feeling healthy - gone! Reported side effects: leg cramps, joint/bone pain, plantar fascia,  leg/foot swelling, women stopping tamoxifen because of the side effects. We are worried about how it affects our exercise and competitions.

But I understand the science: a great risk reduction in cancer recurrence. Even in studies with women older than 70. And I am in my 50's - there is time for breast cancer to recur.

What a silly thought: "putting the breast cancer episode behind me".  I will have a daily reminder taking this pill in the foreseeable future.

Sisterhood of breast cancer athletes

At the time of breast cancer diagnosis there is much uncertainty, including about the future of competitive sports. When, what, and how much exercise post surgery depends on extend of surgery, reconstruction or not, post surgical recovery, adjuvant treatment such as radiation or chemotherapy, complications (lymphedema etc), age, fitness level, type of sport.

Recommendations from the medical field are very general and thus of limited use for athletes. This was my motivation for this blog: what is possible over time? At not yet 8 weeks post surgery it is still early in the game, what will I be able to sustain? Where will this path lead me?

We can take inspiration from others who have been there and have made different choices. It becomes clear that breast cancer affects women from many paths and that my first reaction "Huh? Me?"  is common. We are on this road together.

Courageous women athletes:

Jen Hanks, professional mountain biking (diagnosis age 35):  http://athletefightscancer.blogspot.com and her recovery path (http://athletefightscancer.blogspot.com/2017/11/a-little-update.html)
Leanda Keahi-Bevans, weightlifting (diagnosis 52): World Masters Weightlifting Championship 2018 medals

Novlene Williams-Mills, track and field (diagnosis age 30):  http://espn.go.com/espnw/athletes-life/blog/post/14729/competing-olympics-even-cancer
Sonya Byrd, bodybuilding (diagnosis age 38): Confidence and bodybuilding, Winning competition

Ellyn Robinson, weightlifting (diagnosis age 43): Robinson Weightlifting
Dianne Chellew, marathon kayak (diagnosis 45, mets at 64): Breast Cancer Australia Newsletter 2000(page 8) and Masters Games (last 2 pages)

Linda Elstun, Crossfit (diagnosis age 50):  http://wwmt.com/news/local/breast-cancer-survivor-credits-crossfit-with-saving-her-life
Shanna Nasche, yoga (diagnosis age 54): Finding my lost dog: yoga after a mastectomy
Karyn Marshall, weightlifting and Crossfit  (diagnosis age 55):  TedX: Shattering Records and Glass Ceilings
Team of athletes: Dragon Boat racing

There are many breast cancer blogs, written by creative women, not about athletes, but with a wealth of information: The Accidental Amazon, The Daily Breast, Invasive Duct Tales, The Breast Blog in the World, But Doctor I Hate Pink,  regrounding.me, or more: Blog roll or stories

Workout log after the 6th week postop

TOTAL core about 1.5 hours
TOTAL cardio about 1 hour
TOTAL weightlifting training about 6 hours

This is week 6-7 post surgery.

Not included in the daily summary, usually in the evenings: restorative yoga (legs up the wall, supported backbend, supported child pose, stretches), PVC pipe work (Burgener warm-up, pull positions)

May 29 (Sunday):  about 1.5 hours
Cardio: 30 minutes cycling with speed intervals, 10 min rowing
Strength: 10 box jumps, 20 min isolated arm muscles

May 30 (Monday):  about 1 hour
Cardio: 20 minutes cycling with speed intervals
Strength: 20 min isolated arm muscles,  20kg bar good mornings, pulls
                isolated leg muscles

May 31 (Tuesday): 2 hours + 20 min
Core: 20 min Pilates
Strength: skill session on snatch including warm-up

June 1 (Wednesday): 30min
Core: Pilates
Strength: isolated arm muscles

June 2 (Thursday): 2 hours + 1 hour
Tai Chi (1 hour)
Strength: weightlifting training including snatches (total 41), front squats (total 15)

June 3 (Friday): 2 hours
Strength: weightlifting training including clean & jerk (total 34) and front squats (total 25)

June 4 (Saturday): 1 hour
Core: Pilates


Since it added up to a lot, my weightlifting coach suggested to return to the training plan and possibly reduce weight and/or reps. This should make for a more balanced weightlifting training. Starting next week. This is about 3 weeks sooner than I thought I could. I am delighted!