healing physically after breast cancer

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40 COPING September/October 2006 To subscribe or be a Coping ® writer, visit www.copingmag.com T he great irony with breast can- cer is that women usually feel much better before treatment begins than when it is over. Oncolo- gists have to contend with the dual and opposing mandates to save lives and adhere to the Hippocratic Oath, “first, do no harm.” If I had gotten pneumonia instead of cancer, I would have gone to the doctor with a raging fever, difficulty breathing and profound fatigue. My physician would have prescribed an- tibiotics that would have improved my general state of health. While I am truly grateful that there are treat- ments available for breast cancer, there is no doubt that when I finished my last chemotherapy session, I was in a much frailer state than I had been a few months earlier. Since I spend my working hours helping people heal from all types of serious injuries and illnesses, I knew what I had to do to facilitate my phys- ical recovery. First, I formulated a plan. I was pretty sick, and I needed to focus on those things that are most important in physical healing – begin- ning with small goals that I could achieve and build upon. What kept running through my head was the mantra, “I want to heal faster, better, and stronger.” It took me many months to heal myself, and after I did, I started a pro- gram called RESTORE (Recovering Energy and Strength Through Oncol- ogy Rehabilitation Excellence) at my hospital that focuses on physical recovery in cancer survivors. RE- STORE is now a model for other hospitals across the country. Though there are many facets to healing that we focus on with RESTORE, the following are three key things that survivors can do to help themselves physically heal. While physical recovery is a very im- portant topic by itself, in women with breast cancer it is particularly critical because early research has shown that exercise (an important component of physical healing) may help prevent cancer recurrence. Buy a pedometer and record how many steps you take each day. This is an inexpensive and easy to use de- vice. You can purchase one online or in most sporting goods stores. Gradu- ally increase the number of steps you take until you reach 5,000 steps daily. Most people can accomplish this goal within the first four weeks. Over the next three months, increase your steps until you reach 10,000. It’s a good idea to check with your doctor about exercise (and I recommend that you do this), but most women can safely increase their steps unless they have a serious heart or lung problem or low blood counts. Eat three medium sized meals and two nutritious snacks every day. Good food helps to repair injured tissues and organs. Moreover, fatigue is one of the most disabling problems in breast cancer survivors. While diet isn’t the solution to all fatigue prob- lems, going too long without food or skipping meals altogether contributes to a low blood sugar level, which worsens fatigue. Also, since many women gain weight during treatment, this meal-snack schedule can be a good way to shed unwanted pounds. Sticking to a healthy and regular schedule means that you are less likely to feel ravenous at mealtime and overindulge. Give up taking naps and sleep well at night. Poor sleep, no matter what causes it, is detrimental to physi- cal healing. Naps tend to interfere with good sleep at night and are usually better to skip once you are finished with chemotherapy and radia- tion. At night, it may be hard to fall asleep or stay asleep due to worry, hot flashes, or pain. If you are not getting at least seven to eight hours of quality sleep most nights, talk to your doctor about how you can improve your rest. Optimizing your physical health after breast cancer treatment is a process that takes most women many months. However, there are things that you can do to facilitate healing and recover more fully. As Confucius stated, “A journey of a thousand leagues begins with a single step.” Taking the three “steps” that I out- lined above will get you started on the right path in your healing journey. Editor’s Note: Dr. Julie Silver is an assis- tant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. She is a 2006 recipi- ent of the prestigious Lane Adams Quality of Life Award from the American Cancer Society and is the author of the book, After Cancer Treatment: Heal Faster, Better, Stronger (Johns Hopkins Press). COPING’S 2006 FOCUS ON BREAST CANCER Healing Physically After Breast Cancer by Julie Silver, MD Focus on those things that are most important in physical healing. Dr. Julie Silver Cg SO 06 40-49:Layout 1 12/3/09 2:48 PM Page 40

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40 COPING K September/October 2006 To subscribe or be a Coping ® writer, visit www.copingmag.com Dr. Julie Silver to help themselves physically heal. While physical recovery is a very im- portant topic by itself, in women with breast cancer it is particularly critical because early research has shown that Cg SO 06 40-49:Layout 1 12/3/09 2:48 PM Page 40

TRANSCRIPT

40 COPING � September/October 2006 To subscribe or be a Coping® writer, visit www.copingmag.com

The great irony with breast can-cer is that women usually feelmuch better before treatment

begins than when it is over. Oncolo-gists have to contend with the dualand opposing mandates to save livesand adhere to the Hippocratic Oath,“first, do no harm.”

If I had gotten pneumonia insteadof cancer, I would have gone to thedoctor with a raging fever, difficultybreathing and profound fatigue. Myphysician would have prescribed an-tibiotics that would have improvedmy general state of health. While Iam truly grateful that there are treat-ments available for breast cancer,there is no doubt that when I finishedmy last chemotherapy session, I wasin a much frailer state than I had beena few months earlier.

Since I spend my working hourshelping people heal from all types ofserious injuries and illnesses, I knewwhat I had to do to facilitate my phys-ical recovery. First, I formulated aplan. I was pretty sick, and I neededto focus on those things that are mostimportant in physical healing – begin-ning with small goals that I could

achieve and build upon. What keptrunning through my head was themantra, “I want to heal faster, better,and stronger.”

It took me many months to healmyself, and after I did, I started a pro-gram called RESTORE (RecoveringEnergy and Strength Through Oncol-ogy Rehabilitation Excellence) atmy hospital that focuses on physicalrecovery in cancer survivors. RE-STORE is now a model for otherhospitals across the country.

Though there are many facetsto healing that we focus on withRESTORE, the following are threekey things that survivors can do

to help themselves physically heal.While physical recovery is a very im-portant topic by itself, in women withbreast cancer it is particularly criticalbecause early research has shown that

exercise (an important component ofphysical healing) may help preventcancer recurrence.

Buy a pedometer and record howmany steps you take each day. Thisis an inexpensive and easy to use de-vice. You can purchase one online orin most sporting goods stores. Gradu-ally increase the number of steps youtake until you reach 5,000 steps daily.Most people can accomplish this goalwithin the first four weeks. Over thenext three months, increase your stepsuntil you reach 10,000. It’s a goodidea to check with your doctor aboutexercise (and I recommend that youdo this), but most women can safely

increase their steps unless they havea serious heart or lung problem or lowblood counts.

Eat three medium sized mealsand two nutritious snacks every day.Good food helps to repair injuredtissues and organs. Moreover, fatigueis one of the most disabling problemsin breast cancer survivors. While dietisn’t the solution to all fatigue prob-lems, going too long without food orskipping meals altogether contributesto a low blood sugar level, whichworsens fatigue. Also, since manywomen gain weight during treatment,this meal-snack schedule can be agood way to shed unwanted pounds.Sticking to a healthy and regularschedule means that you are lesslikely to feel ravenous at mealtimeand overindulge.

Give up taking naps and sleepwell at night. Poor sleep, no matterwhat causes it, is detrimental to physi-cal healing. Naps tend to interferewith good sleep at night and areusually better to skip once you arefinished with chemotherapy and radia-tion. At night, it may be hard to fallasleep or stay asleep due to worry, hotflashes, or pain. If you are not gettingat least seven to eight hours of quality

sleep most nights,talk to your doctorabout how you canimprove your rest.

Optimizingyour physicalhealth after breastcancer treatment isa process that takesmost women many

months. However, there are thingsthat you can do to facilitate healingand recover more fully. As Confuciusstated, “A journey of a thousandleagues begins with a single step.”Taking the three “steps” that I out-lined above will get you started onthe right path in your healing journey.

Editor’s Note: Dr. Julie Silver is an assis-tant professor at Harvard Medical Schoolin the Department of Physical Medicineand Rehabilitation. She is a 2006 recipi-ent of the prestigious Lane Adams Qualityof Life Award from the American CancerSociety and is the author of the book,After Cancer Treatment: Heal Faster,Better, Stronger (Johns Hopkins Press). �

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Healing Physically AfterBreast Cancerby Julie Silver, MD

Focus on those things that are mostimportant in physical healing.

Dr. Julie Silver

Cg SO 06 40-49:Layout 1 12/3/09 2:48 PM Page 40