What we say or how we react

"There is no single right approach and no simple answer to dealing with the human side of cancer." 

--JC Holland, The Human Side of Cancer

You will find out that you are not the only woman with breast cancer and that breast cancer patients come from all paths of lifestyles. Beware that incomplete information can result in erroneous ideas, and decisions may be made without backing of scientific evidence.

Upon hearing of a breast cancer diagnosis or treatment, people have to deal with their fears and uncertainties. That includes both sides, women who get the diagnosis, and people who come in contact with these women. We can switch between numerous coping mechanisms during a cancer journey.

Here are some coping mechanisms/attitudes of women with a cancer diagnosis:
Avoider/Procrastinator:  Me? It can't be that bad. I don't need to see a doctor/get treatment/...
Fighters:  I am going to beat this thing. I am going to start exercise/meditation/acupuncture/....  I choose to do the most aggressive treatment, chemo, mastectomy,  even if it is not needed scientifically.
Stoics/Non-fighters: Accept and endure what comes, but I don't go out of my way to seek new treatments.
Paranoid: May choose aggressive treatments so that the cancer won't come back.  I can (will) die from this even though the diagnosis was 15 years ago.

Here are some coping mechanisms by people who hear about your cancer journey:
Cheerleaders: You'll be fine. They caught it early. You don't look like you have cancer.
Therapists: This is because you have too much stress in your life (bad job, difficult relationships, ...). Think positively, so that you can beat the odds.
Fighters:  Who needs boobs, cut them off. Get over it and move on.
Problem Solvers: You can cure your cancer, if you take whatchamacallit, or become a vegan, or ...
Unsure what to say, but want to say something: The relative of a friend has cancer and has such and such an experience.
Clichés: Everything happens for a reason. Think positively.

Bad things happen:
"Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.[...] Sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place."

--Susan Sontag, Illness as Metaphor

What can we do?
Cancer patient: Separate fact from fiction and seek medical help, and otherwise stay with the attitude that comes natural.
Supporter of the cancer patient: Listen! Say you are here for them. Give some concrete suggestions how you can help.
P.S. Take this moment to familiarize yourself about choices such as mastectomy or reconstruction and what decisions you might be inclined to make. It might happen to you in the future.

One year follow-up

Exactly 12 months ago was my bilateral mastectomy.

As a celebration I competed in a local weightlifting competition. This event was also my first competition a year ago. Despite the weight loss and although I hand't managed such weights in training I really wanted to repeat the weights lifted for the clean & jerk a year ago, 55kg - 58kg - 61kg.  It went fine until the clean of 61kg, which I caught badly. I was feeling disappointed that I had to drop it. But  then I thought "No way am I going to loose this bar!!!" And with sheer willpower and a little stumbling on the platform  I managed to save it. It is surprising how little time it takes to think all these thoughts and feel all these feelings and still act timely.

On the one hand I am much healthier now than I was then and feel awesome. The one year follow-up tests (blood lab values) were super good and better than before.  And I think about the cancer less and less, although it is a chronic disease.
On the other hand I have to take Tamoxifen for 4 more years. It has side effects. I take only half the dose to the dismay of the oncologist. Clearly tamoxifen has a good track record (it's been around for 30 years) of preventing recurrences. The unanswered question is how to balance the risk of recurrence with the risk of long term side effects increasing comorbidities for somebody with little or no risk factors like myself.

Benefits of competitions

It is well known that we benefit from exercise. How about the challenge of competitions?

In the preparation and participation for competitions we can find enjoyment in the physical improvements and testing our limitations, getting positive effects on mood from the training, being motivated to pursue regular, intensive exercise in order to reach the goals for competitions. Meeting other women weightlifters at the competitions and staying in contact via social media enriches life. In interviews at the World Masters Games in Sydney 2009 competitors aged  56-90 identified five themes, namely enjoyment of challenges, satisfaction with what their bodies are capable of, winning, motivation, and companionship ("Older athletes perceived benefits of competitions")

Competitions and training for competitions provide physical and mental challenges.  One has to deal with doubts or unreasonable expectations and finding a balance. There is the risk of injury, typically measured in number of incidences per 1000 hours of activities in the chosen sport. It is relatively low in weightlifting compared to ball or contact sports or running (Pakkari et al. Active living and injury risk.  Int J Sports Med 2004; 25: 209-216).  Injuries or comorbidities (such as cancer) make it necessary to adjust the training and not being able to achieve what one hoped. However at the competitive level athletes make these adjustments and continue to train.  In the documentary Impossible Dreamers (2016)  a 68 year old swimmer talked about how "something inside her kept her going and going" after a surgery so that she was able to break the world record a year later. An 85 year old sprinter said that "we don't let things stop us from max effort." A 94 year old yoga teacher and dancer said that it is the dance of life inside her, and that she tells her students not to give in to anything but to know that they can recycle their own bodies. 

At competitions we learn how to deal with our nervous system so that we can focus and find a still point that allows us to be at our best. It can be helpful to dedicate our efforts at a competition to something. For example, I wanted to succeed (meaning to participate and do well) at the world masters weightlifting championships for my breast cancer sisters in the world, and as an example that breast cancer need not stop us. There are many women with breast cancer diagnosis who participate in competitions at the highest levels: Sisterhood of breast cancer athletes

Cancer Care Bag

A girl scout group is designing a cancer "care" bag for anyone going through cancer treatment.  This is such a delightful idea. Cancer treatments  are at different stages: surgery, chemo, radiation, hormone therapy, side effects of any of these. To keep it generic here are feel-good suggestions:

1. a fun (self made?) tote bag with some of these:
2. peppermint essential oil
3. 4 fl.oz of massage oil, e.g. apricot kernel oil, almond oil, coconut oil 
4. eye pillow with lavender scent 
5. CD with relaxing music
6. a journal and pens/pencils
7. stress toy
8. a fancy scarf
9. IOY for cooked meals, shopping, cleaning, mowing, etc...
10. gift card for Amazon or iTunes  

Benefits of Bilateral Mastectomy

1. no more bras (especially during the summer!)
2. no more mammograms
3. closer hugs ❤️
4. chest massage
5. Fashion:
• wearing fancy shirts backwards
• smaller clothing size
• wearing men's shirts  
• tank tops don't show bra straps
6. Sports:
• push-ups are easier
• streamlined for olympic weightlifting and other sports 🏊
• jumping on a trampoline
7. better posture 💃

Tamoxifen Blues

Tamoxifen is prescribed for premenopausal women, when the breast cancer is determined to be estrogen receptor positive. It is to be taken for 5 long years (or longer, if newer studies are to be believed).

Every morning I look at the little white pill and have to remind myself of the abundant scientific evidence from the last 30 years to prevent recurrence, so that I work up the will to take it. But I resent the side effects that accompanies this medication. Five years of diminished quality of life.
There is a whole host of side effects: https://www.drugs.com/sfx/tamoxifen-side-effects.html Side effects that I experience are

• brain fog/memory lapses. Reduction in cognitive function is very disturbing! Sometimes this may lead to forgetting to take the little white pill.
• red face. I mean really red. Chin and up red, throat and down white. Heat, cold, stress, thinking thoughts that make me tense, and more, can bring it on. This is really weird at the work place.
• depression
• dry skin and dry, itchy eyes (terrible in my job having to work on a computer a lot)

I must admit that in the beginning I skipped some doses, and then for a while I took only half the dose (10mg). It is a long acting drug, and will stay in the body for months after stopping, so it is not terrible to skip a day. 

What may help to prevent such side effects:

• relaxation (to remove stress)
• plenty of water (2.5 liters a day, red face points to inflammation processes)
• lots and lots of exercise (it is always better afterwards even if only for a little while)
• some women swear by supplements: vitamin D3, vitamin B12, magnesium (I don't know, but I take it anyway)

For somebody who has never used supplements or avoided putting foreign substances such as medications in my body, this is a downer. The alternative is to take more drugs to combat the side effects.  Another drug is Aromatose inhibitors (AIs) prescribed for postmenopausal women but comes with its own side effects. Common is the drastic reduction in bone mineral density. I am weightlifter! This activity might make fractures more likely when taking AIs. And switching medication will require another application to the US Anti Doping Agency and a lengthy process to get a Therapeutic Use Exemption. These drugs do nothing for performance enhancements, but are on the forbidden list because they mask side effects of steroid use in men.

The side effects are supposed to get better the longer one takes the drug. Let's hope!

Christmas after cancer diagnosis

Christmas is a good time to be surrounded by loved ones or to feel loved by our global circle of friends and family.

The first Christmas after a cancer diagnosis can be an emotional time. We have done all we can (and continue to do so) to rid our bodies of cancer cells and make it much less likely to recur. At this time of the year the breast cancer sisterhood on dedicated breast cancer social media sites reaches out with good wishes and prayers and encouragements for things to get better or not to get worse. Some women post Christmas wishes, but their loneliness in their struggles can shine through.

We reflect on where we are, such as constantly watching out and being careful about activities. We can be easily frustrated about not being able to do things that we wouldn't have thought twice about before. We are worried about not having the same energy level as previously, or we may be battling side effects from medications. 

We reflect on where we were, and it fills us with astonishment how far we have come. Here are a few reflections on some practical experiences from the gym:

• needing a pillow under the seat belt straps to protect the scars when driving to the gym
• needing a shoe horn to put on weightlifting shoes, because bending forward after a mastectomy is painful
• needing great abdominal strength, so that lying down to rest and recuperate and getting back up is easy during the training 
• needing a helper to carry 10 kg weight plates and set up the rack to get ready for back squats every single time
• Being super, super grateful for the presence of other weightlifters, encouraging, helping, showing interest.

Christmas season is the time we can offer encouragement to other women with breast cancer, sharing our experiences and our paths, we can listen and offer our cyberspace presence, and hopefully alleviate some of the loneliness. 

We also need to give ourselves permission not to be Superwoman to clean, cook, bake, shop,  and prepare for the Christmas celebrations. Forge new experiences or new traditions by having faith in others and letting them do things their way!

In the work place

For a few weeks after mastectomy I was fortunate to be able to work online at much reduced hours. It was very helpful to devote time to recovery and taking frequent naps. So it took a while before seeing my colleagues (mostly male) again.

One decision before returning to work after mastectomy is about looks. I love the breast-free feel. I don't like bras unless they are super comfortable and I can breathe and expand my rib cage.  I had so gotten used to being breast-free in just 9 weeks post surgery that wearing breast prostheses felt like trying on high heels as a little kid. Neither my husband nor my son cared.  So before going back to work I made the decision not to wear breast prostheses. Everybody would just have to get used to my fabulous new physique. In the weeks away from the office I lost a lot of weight by watching my nutrition and spending much time in the gym. To recover from surgery and combat side effects of Tamoxifen it helps to 1. exercise often, 2. drink a lot of water, 3. eat plenty of greens, and 4. sleep.

After returning to work a few colleagues felt sorry for me because of the breast cancer, they probably thought the weight loss was due to the cancer treatments.  But the overwhelming reaction from my colleagues had to do with how fit (and slim) I looked. They were impressed and envious.  So timing the return to work this way was a great boost to the ego.
Beyond my immediate office environment it was a study in communication networks. People don't notice a flat chest, unless they know about the mastectomy. So when someone stared at my chest, I knew that they must be well connected to the grapevine.
More recently, my colleagues found out about my weightlifting successes, and found it interesting and inspiring for themselves. So now they can see me without thinking about breast cancer. And it is less on my mind also.
I did ask for a lighter work load and made sure the key people knew that I am less energetic at the moment and am dealing with tamoxifen side effects. So hopefully it was understood and forgiven when I skipped committee meetings. After 7 months I still have less energy, although every week brings improvement. It is astonishing that even though I felt recovered when I first returned to work, I clearly notice how much better it is now from only a few weeks ago. And weightlifting keeps getting better and better. It also helped to have a thick exercise mat that can be folded up, and a pillow. This is so that I could lie down to take short naps (and I did fall asleep briefly sometimes even weeks after going back to work).

#BreastCancerRealityCheck

The hashtag  #BreastCancerRealityCheck is currently used on Twitter to add some reality to the pink ribbon party the breast cancer awareness month October seems to have evolved into.

Awareness what breast cancer may mean for weightlifting:
1. Dealing with continued swelling due to an interrupted lymph system: learning lymph massage, learning kineseo taping, having to wear compression shirts, avoiding upper body strength exercises, or any exercises that lead to increased swelling.  Lymphedema sleeves are not allowed in competitions.
2. One may need to argue about long sleeve compression shirts in competitions. They are allowed according to IWF rules, although not everybody knows this.
3. Getting a Therapeutic Use Exemptions (TUE), since breast cancer drugs are on the forbidden list in and out of competition.
4. Suffering through side effects of said breast cancer drugs that will lead to inferior performance in weightlifting.
5. Figuring out clothes: women's don't fit after a mastectomy,  and men's can be too wide in the shoulders while being too narrow in the waist.
6. Being grateful for any services that are offered at no cost. Out-of-pocket health care related costs amounted to close to $5000 this year.
7. Of the 221 women registered at the World Masters Weightlifting Championship, 27 (=1 in 8 is the rate reported for US women) are expected to get invasive breast cancer during their lifetime. Little do they know. Bad things happen even with positive thinking, healthy life styles, or low cancer risk.

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!

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

Delightful woman in no distress

The essay "Nice 67 Y.O. male has brush with mortality" by Garrison Keillor (September 2009) made me wonder whether attributes for patients are commonly used in clinical notes. So I looked up mine. And sure enough "very pleasant 52-year-old female", "absolutely delightful 52-year-old woman", "delightful woman in no distress" are recurring themes. I am delighted to read this, of course.  In the essay, the nice 67 y.o. man said he had an edgy 27 y.o. man inside him. And I do know exactly what he means despite my calmness that was noted in the reports.

"She is well versed in the literature" and "she has done significant research in this regard" makes me wonder whether biostatisticians make difficult patients, because we question numbers, or easy patients, because we are thinking carefully? During the appointments I very much enjoyed the discussions about risk factors and probabilities, and learning more about treatments and expectations. Stephen Jay Gould commented in his essay "The Median isn't the message" how impossible it is to keep an intellectual away from literature. However, as researchers may well know, it is also easy to selectively choose literature to support one's hopes or fears. I am very grateful for my scientific friends and the doctors who were able to point out other studies to arrive at a more well rounded view of things.

It is also helpful to understand variability. The literature reports averages, which is not necessarily what outlooks are for individuals. This is more than clear when looking at forum posts where a range of experiences are reported, each are slices in time. It is to be expected that recovery paths and post exercise regimes can be quite different from one individual to the next.  Whatever path it will be, a "no distress" attitude makes life much easier.

Looks

Before surgery I looked at photos of brave women who posted their chest photos on the internet to make sure I (and my husband) would be prepared for how I may look afterwards. Not a pretty sight! However a nice husband like mine will tell you that it is much better to have you well without breasts than for you not to be there.

Reality check: after surgery I looked down my chest and thought: "I am going to like this."  I could move my shoulders, had good balance when getting up, and had a "leaner" look from the side. Love it! Many athletes don't have large breasts anyway, so I will fit right in.  Actually, most people don't notice anyway.

The first time after mastectomy meeting my friends they did look at my chest at least once. Curiosity. I would be, too. I was waiting for it.  I did think about confusing them by wearing a  breast form that comes with the postop camisole. But I will save that for my male colleagues when I get back to the office.

It is such a delightful thought that I don't have to wear bras anymore. For special occasions there are breast forms ("props"). Time will tell.

There are suggestions on the internet about clothing for the new you:

• colorful, swirly designs, busy patterns
• darker colors
• scarves
• vests or blazers
• jewelry and ornaments

Women choosing no reconstruction http://breastfree.org  or http://www.flatandfabulous.org

Feelings

Feeling a little low on Saturday. No desire to exercise. So lots of resting and watching Netflix TV series.  I do notice that not drinking at least 2 to 2 ½ liters of water makes a difference and I am upping the water intake.

The fluid retention under the arm (a water balloon?) can be very annoying. It is also difficult to live with the uncertainty whether complications will eventually arise (wound dehiscence, hematoma, seroma, lymphedema). "Eventually" may mean 6 weeks for wound complications, 3 months for seroma, 2 or more years for lymphedema. That's a long time of not knowing whether I a doing something too fast or need to do less.

However on Sunday I am “back in the saddle”, on a stationary bike, and am able to do high intensity speed intervals with a lot of huffing and puffing, but it feels AWESOME!

Normal daily activities

You will have been told that you can return to normal daily activities 2 weeks post mastectomy.
Hopefully you will also have been told to abstain from carrying laundry baskets or vacuuming.

If you have help, use it!  Asking for help can be a great learning experience. It is not easy (for me)!

Normal daily activities can be more challenging than doing deadlifts in the gym (which you are told not to do so soon). However I found that exercises in the gym including strength training are carefully controlled movements while normal daily activities can be complex movements (cleaning) and may involve heavy weights (grocery bags) that are not necessarily appropriate.  Be realistic!

Showering did not happen for me until a week post surgery. Wash cloths and baby wipes work, and a hair wash in a salon feels great. 

Walking can be painful and wasn't comfortable until almost 4 weeks post surgery. Go easy.

Having cleaning help is a blessing.

Chopping carrots (or other hard vegetables) can be a strain. Directing your teenage son to chop various kinds of vegetables for a vegetable korma dish is a great learning experience for him.

Allowing others to help can make them feel good about themselves. Asking for help can be a great learning experience!

Driving

11 days post surgery

With a pillow in front of my chest under the seat belt, a nervous husband by my side, I am driving the car for the first time. We are heading to the fitness studio.  It feels wonderful to get on a stationary bike for 20-30 minutes.

Heading home

Last appointment with the oncologist and then it is time for the 9-10 hour drive home. I am feeling so much better. It would not have been comfortable to leave for such a long drive earlier.

And I can stretch my arms up the wall with hips almost flush to the wall. Great!