As featured in the Spring 2015 issue of the Yoga Therapy Today by IAYT. Download the pdf here Spring2015_YTIP_NavigatingCancerland.
Fourteen years ago, when I heard those three words, “You have cancer,” they took my breath away. A cancer diagnosis is like falling off a swing as a child—the shock, hitting the hard ground, that thud sound, then the gasp for air, all in a split second. That is how I felt.
No matter the type or stage, cancer is a cold new reality. I survived the initial shock only to find myself enrolled in Cancer Boot Camp, what the late Christopher Hitchens called “cancerland” because of its strange customs and scary words. 1 Suddenly, I had to learn medical terms like “sentinel node biopsy” and “metastasis;” I heard about remedies like macrobiotic diets and mistletoe treatment that sounded odd to me, and I heard frightening statistics about survival rates. There was no time to sort out personal emotions before making life-and-death decisions. I found myself flooded with emotions and existential questions. How could this be happening? What did I do wrong? Why me? What do I do next? It was all so exhausting.
I had to get this roller coaster under control. Just as frustrating were all my questions about cancer as a disease, the treatment options, and their long-term side effects, none of which were ever fully explained by either my surgeon or oncologist. So, I read as much as I could, and I learned that there are few simple answers to what causes cancer or how to cure it. Sometimes, even though we follow health guidelines, don’t smoke, and eat right, we develop a cancer that starts with a random cell mutation.
When the diagnosis conversation started, my first question to my doctor was, “How do I get rid of it?” My doctor explained the basics: what a tumor is, why it should be removed, how that is done, and what happens after that. At first, I could barely hear the words, and I certainly didn’t understand them. I had a serious breast cancer—a large palpable tumor— and the treatment regimen would be aggressive because of the tumor grade.
The prescription given to me was the conventional Western route: lumpectomy surgery to remove the tumor, chemotherapy for ten months, then radiation. My navigation through the healthcare system started with a sentinel node biopsy, which is a diagnostic procedure to remove lymph nodes in the chest wall to check for possible metastasis outside the original tumor. Before cancer, I had no idea how many lymph nodes lived in my body, or where they were. My understanding of the immune system was minimal. That would all change.
Cancer treatments force you to think about the smallest details of daily life. I had worn a long-sleeved T-shirt to the hospital for my second surgery, but I had to use a surgical scissor afterwards to cut it open because I could not raise my arm over my head. No one had told me how to dress for cancer surgery! (Wear shirt that buttons up the front.) More seriously, no one told me that removing lymph nodes in the chest wall would traumatize the pectoral muscles.
Fears began to pile up fast. Range of motion was gone in my right arm. Removal of lymph nodes created the risk of lymphedema: a disfiguring, physically limiting condition in which lymph fluid builds up in tissues, causing swelling. As many of my yoga students now express, fear of lymphedema can be stronger than the fear of dying. Then came the warning that the loss of sensation in my right arm could be irreversible. After surgery and before chemo, my nurses explained how I would empty the surgical drains left in my chest wound and wished me well as I took the first step on the path of survivorship and went home.
Honestly, I left the hospital grateful for the knowledge and expertise of my doctors and nurses, but also feeling let down, alone, and with many more questions and fears than answers. Leaving the hospital, I had a fistful of pain meds, but no prescription to manage long-term side effects. I was warned what not to do, but not prepared with any “this is what you should do.” The big questions about living with cancer and rebuilding my life were never discussed. Caught up with so many details, I didn’t think to ask those questions, and my doctors didn’t think to volunteer such answers. Perhaps someone tried, but I was too distracted to hear.
Chemo was next, which is when I started to think about yoga. (For six years prior to my diagnosis, my practice three times a week combined Iyengar, Ashtanga, and self-practice.) Up to this point, cancer had been a great teacher. Chemo drugs, of course, are poisons designed to kill cancer cells, and in the process they kill other fast-growing cells such as hair follicles. As everyone imagines, the chemotherapy procedure creates anxiety, but it also produces new fears such as about the damage to healthy cells and a further loss of personal control. Fear is not pleasant and feeling vulnerable is hard work. Anxiety causes muscles to tighten, palms to sweat, your mouth to get dry as blood pressure and respiration rates elevate. Was I breathing? No! Gone again, that critical supply of life-giving oxygen. That I was holding my breath was a pivotal realization in my recovery.
I learned to use two yoga tools, gifts really, to prepare myself for chemo: breathing and meditation. In the past, I had underestimated meditation. Now, it allowed me to rest my mind whenever I chose, especially in the chemo chair. I could monitor my thoughts so I could go to sleep at night. I felt in charge again. With breathing and meditation I was grow- ing emotionally stronger, giving myself a way to strike a bargain with my treatments. Breath counting did not work for me, but alternate nostril breathing did. I was in control, not the chemo.
In New York at that time I found only one class for survivors, most of whom were advanced Stage IV and the focus was restorative yoga. I also started to rebuild my former yoga practice—slowly and gently, of course, but with a different focus. What interested me was not so much what I could not do, but what I could do. I was surprised when I brought my attention to other parts of my body that were healthy, like my legs, which seemed eager, ready to move and stretch.
Chemo made me tired. had expected that and anticipated the cumulative effect as I became bone-weary. However, an active yoga practice helped. It gave back energy. At the same time, I was growing emotionally stronger. It seemed that yoga focused me on the path of being a healthy survivor. I became curious. How and why were these effects of yoga happening?
At each stage of recovery, I experienced something different in my body and I had to adapt my yoga practice to the changes. Many questions arose in me about the effects of cancer treatments. But I also had questions for yoga: How to use yoga to optimize my health and to feel comfort- able in the body I now had?
When chemo finished, I asked myself whether my yoga practice needed to be different. Usually, restorative yoga with guided meditation is recommended for cancer patients and survivors. Was this what I needed?
My hope was that yoga could be a way to reclaim life during and after my cancer treatments, to get me back to normal. Hope, though, was not a plan; yoga was. I placed great expectations on yoga to give me full range of motion lost in surgery, to manage my fears, to help me flush out chemotherapy toxins, and to strengthen my immune system to resist a recurrence.
I wanted to know: What poses would be most important? How can yoga be healing and why? What are poses to avoid? What are the specific benefits and modifications for specific cancers? What is the science behind yoga? How does it work on a cellular level?
I was not a yoga teacher fourteen years ago, so I asked my teachers:
- Will downward-facing dog cause lymphedema?
- Would Hot Yoga be a good way to flush my body of chemotherapy toxins?
- When is it safe to start doing yoga after starting treatments?
- If I have implants, could they rupture doing yoga?
- Is it okay to practice yoga with axillary nerve damage?
- Forward bends cause me pain. Am I doing something wrong?
In the fourteen years since my diagnosis, research has begun to show evidence of yoga benefits for those with cancer. Along with patient navigators,some oncologists now recommend yoga. However, there are still many skeptics in the medical field, and much research needs to be done to bring yoga into main- stream care.
I believe yoga as a wellness plan improves the odds against cancer, giving survivors the tools to fight more effectively during active treatment or in the years after. Yoga helped me cope emotionally and physically with chemo, radiation, and other treatment challenges. This is the prescription I envision yoga folk and health care professionals giving: “Here is your last prescription. Do yoga.”
Finally, in speaking to yoga teachers and therapists as well as healthcare professionals, my experience led me to develop these guidelines:
- Be prepared with answers to the questions, anticipated and unanticipated, that will come about yoga and cancer.
- Learn the facts about cancer. Know that true compassion flows from knowledge and facts, not just from the heart chakra.
- Learn the benefits of yoga as exercise beyond a relaxation technique. Acknowledge your own fears about cancer.
- Acknowledge your own fears about cancer.
- Encourage the curiosity of your patients and students who want to know how yoga works and how to live with cancer.
- Appreciate that your patients want your recommendation on how they can participate in their healing.
- Be aware that the science of yoga and cancer is still in its infancy. Stay open to the limits of our understanding and the possibility of misunderstanding. Yoga, like cancer, has scientific as well as spiritual dimensions.
Yoga empowered me to be healthier and stronger than I ever was before cancer. It taught me how to live with the uncertainty of recurrence and with lifelong side effects, and it helped me create my mantra: “Cancer steals your breath. Yoga gives it back.” A life-threatening illness can help us all learn how to live fearlessly—if faced directly. Both cancer and yoga are great teachers.
Tari Prinster, a cancer survivor, yoga teacher, and author of Yoga for Cancer, developed the y4c methodology using contemporary research on cancer and yoga. Since 2003, Tari has trained more than a thousand yoga teachers and worked with thousands of survivors.
1. Hitchens, C. (2010). The topic of cancer. Vanity Fair. Retrieved from http://www.vanityfair.com/ culture/2010/09/hitchens-201009
2. Prinster, T. (2014). Yoga for cancer: a guide to man- aging side effects, boosting immunity, and improving recovery for cancer survivors. Rochester, VT: Healing Arts Press.