Healing After Breast Cancer Treatment
Arline Kallick: Hello everyone and we’re happy to have you with us this evening. Our call will begin with tonight’s speaker, followed by a question and answer session and then end with small group discussions; and please consider that there are many waiting on line to ask a question so try to limit your question to one per caller. Remember, that this is cannot be a private consultation. If we go into the group before you have the opportunity to ask your question, you can address it in the group; call the Y-ME 24-hour Hotline at 800-221-2141. Our Web site is www.y-me.org. Registration for the ShareRing calls can be done online and transcripts of each ShareRing call will be available in approximately five days following the call.
Tonight’s speaker is Dr. Julie Silver. Dr. Silver is a renowned expert in Physical Medicine and Rehabilitation, which is Physiatry and Assistant Professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. She is an award-winning writer and an author/editor of more than a dozen books, including a number of medical textbooks. Dr. Silver is also a breast cancer survivor. Most recently she is the author of the book After Cancer Treatment: Heal Faster, Better, Stronger. Our topic tonight is Healing After Breast Cancer Treatment, so we welcome Dr. Silver.
Dr. Julie Silver: Thank you Arline. It’s a pleasure to be able to speak to your audience tonight. I prepared some comments on healing that really have to do with some of the basic components and also some of the most common questions I get answered, I get asked.
In terms of the important issues and physical healing, I really focus on physical healing because I’m a rehabilitation doctor so although emotional healing is extremely important and I always like to include that in what I talk about, what I’m really an expert on is physical healing because that’s what I do.
In fact, physical healing and emotional healing go hand-in-hand. The better you feel physically, the better you feel emotionally and vise versa. So they really tag team and help each other out a lot. It’s really hard to feel emotionally good if physically you feel very tired and you’re in pain and you can’t do the things that you want to do.
When it comes to physical healing there are some important things after cancer treatment that really are key and cancer is very unique in medicine in that many people, especially women who are diagnosed with breast cancer, go to their doctors and actually feel really great at the beginning of treatment. They may have had their cancer picked up on a mammogram or maybe they found a lump, but generally they feel pretty good at the beginning of treatment and then the treatment actually makes them sicker and sicker until literally they’re probably sicker than they’ve ever been and then the treatment is finished. So that’s kind of unique in medicine in general because, for instance, you had pneumonia you’d feel really bad. You’d have a high fever and you’d go to the doctor and the doctor would give you some medicine to make you better; so cancer is unique in that at the end of treatment you often feel much worse than you did at the beginning. Of course it’s important to treat the cancer as aggressively as possible. For those of us who have been through treatment, generally we’re thankful that there were treatments available.
So at the end of treatment when you’re feeling tired and in pain and you’re deconditioned, one thing that really seems to be very important is exercise and exercise in breast cancer has been shown to help prevent cancer in the first place. Those of us who have had breast cancer, and I exercised my whole life so it certainly doesn’t work for everyone to prevent cancer, but it certainly is something that has been shown to be helpful potentially in preventing breast cancer in the first place.
It also seems to be helpful in some women and maybe helping prevent recurrence. That scientific research is still ongoing, but the early evidence is very suggestive that in some people exercise will be helpful in prevent recurrence and certainly exercise is helpful in healing and physically healing and getting your strength back, having more endurance and so on.
Because exercise is such a confusing topic, I tell people that they’re really five kinds of exercise, only two of which are usually important in breast cancer. The five different kinds are: Aerobic or cardiovascular, number one; strength training, number two; number three is flexibility or stretching; number four is sport-specific exercise, so that would be like shooting a basketball over and over and getting better at a specific sport; and number five is functional and that involves balance and coordination, for instance, after a stroke.
So the first two, cardiovascular and strength training, seem to be the most important. Sometimes, number three, the flexibility exercises are important, especially for instance after a mastectomy when a women needs to really improve the flexibility in her arm and improve the shoulder range of motion so that she doesn’t have a rotator cuff problem or whatever. But in terms of really physically healing, the two kind of exercise that are important are cardiovascular and strength training.
What people ask me is: How do I start? What I do? One of the best things to do is simply to start walking and what I recommend for my patients is to get a pedometer and just strap it to your belt and start counting how many steps a day you’re taking. That’s a great way to start because, number one, you’re not even really starting to exercise in the beginning. All you’re doing is recording how many steps a day you’re taking right now already. That’s really great to just sort of say, “Well I wonder how close I am to what the recommendations are, the formal recommendations for how many steps a day people should be taking.The recommendation by the American College of Sports Medicine is 10,000 steps a day for active healthy people.
What I recommend is that you record for a week how many steps a day you’re taking and then you average those out and then you try to increase by 500 steps a day week-by-week until you get to 10,000. So each week you try to increase the average number of steps a day you’re taking by 500. At some point it’s worthwhile checking in with your primary care doctor or your oncologist to just be sure that the increased activity is safe for you, but most people can safely walk without any problems, exceptions include anyone with a serious heart or lung problem and occasionally people with metastases have to be careful of this. So that’s usually a very safe way to begin to exercise and the 10,000 steps a day goal is very doable. People really enjoy using a pedometer and sort of gauging it. It’s great feedback every night when you look at it and you can really see your progress and then soon you start feeling a lot better. So that’s one of my first tips.
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