What Yoga Teachers Need to Know About Teaching Cancer Survivors

by Tari Prinster. Published in Kripalu.  See the original here.

What Yoga Teachers Need to Know About Teaching Cancer Survivors

Yoga for cancer patients—what better way to manage anxiety, gain strength, increase flexibility, and create feelings of well-being! A growing body of research points to this path, both during and after treatment. But it’s important for teachers to realize that teaching yoga to cancer patients and survivors is different than teaching yoga in a typical class. Here’s why.

Specialized Training Is Required

B. K. S. Iyengar said it best: “Do not imagine that you already understand and impose your imperfect understanding on those who come to you for help.” Most yoga teachers, whatever their style or practice, are trained to teach a general population. While 200-hour trainings typically include anatomy modules, there’s not enough time to cover specific physiological topics, such as cell development, or psychological challenges, like the acute anxiety induced by a diagnosis of a life-threatening disease. It’s not possible to cover the specific needs or risks of the survivor in a standard yoga training.

A specialized teacher training about cancer, like my Yoga4Cancer(y4c) methodology, helps teachers identify and work with the lifelong side effects triggered by cancer and its treatments. Yoga teachers need the essential facts about both cancer and yoga because understanding, not just compassion, is essential. Compassion might, for example, lead a teacher to provide only gentle or restorative poses for a cancer survivor. But yoga is not just a relaxation technique; movement is necessary to stimulate the cardiovascular and lymphatic systems that assist in recovery and in creating long-term stability. Recent research suggests that the physical exercise provided by yoga improves immune function, reduces inflammation, and enhances the efficacy of chemotherapy and radiation. Still, there are limits, especially right after surgery, or if a survivor is physically challenged. Only training and supervised experience can inform a yoga teacher about safe and effective methods of adapting yoga for this population.

Safety Comes First

Healing begins with feeling safe. Safety for a cancer survivor, whether physical or psychological, can be different than for a typical student. The effects of some cancer treatments go beyond hair loss and fatigue to create serious long-term fragilities requiring special attention. For example, a Forward Bend, a yoga staple, can be dangerous to cancer survivors, because bone loss created by chemotherapy is a common long-term side effect; doing a Forward Bend quickly without warming up can fracture or rupture spinal vertebrae. Yoga teachers who work with cancer patients need to anticipate such risks.

Emotional safety is important as well. Survivors bring their fears to class, such as the fear of developing lymphedema (fluid retention and swelling caused by a compromised lymphatic system), which may be as strong as the fear of cancer. Students need to hear that the teacher understands their fears and will know how to provide modifications of poses or sequences they teach. A student touched by cancer might be struggling to understand the new limitations of her body and will be looking for reassurance and informed advice.

Risk Factors When Teaching Survivors

When teaching workshops or giving y4c trainings, I am often asked about yoga’s benefits. Rarely am I asked about its risks. But, like cancer, yoga is not “one size fits all.” Each survivor’s specific cancer, treatments, side effects, and body are different, and yoga teachers must adapt to their needs. The difference in teaching yoga to cancer survivors is that the risks are higher and a teacher should know what they are.

My short list of risk factors includes:

• Fragile bones that increase the risk of fracture
• Abdominal obstructions and sensitivities
• Weak or missing muscles
• Peripheral neuropathy affecting balance
• A compromised immune system, increasing the risk of infection.

Becoming an Authentic Teacher

When offering a class for cancer survivors, a teacher is saying, “I am responsible. I know what yoga is best for you and I will protect you from possible discomfort and injury, and calm your doubts or fears with knowledge and facts.” Survivors expect teachers to understand three general topics: first, the effects of cancer treatments on the body; second, the poses that have the most benefits; and third, the poses that can be harmful.

Survivors will come with questions:

• Will Downward-Facing Dog cause lymphedema?
• Would hot yoga be good for flushing chemotherapy toxins from my body?
• 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?

Be prepared with answers to questions, anticipated and unanticipated, about both yoga and cancer. Authenticity starts with having answers to such questions without hesitation—and also having the honesty to say, “I’m not sure, but I know how to get the right answer.”

It’s also important that a yoga teacher for cancer survivors takes the time to reflect on and process her personal fear of cancer and dying. It’s easy to feel overwhelmed by the suffering of others. Inexperienced teachers may treat students with hesitation, due to a lack of confidence or their own fears about cancer and dying. In my personal experience as a survivor, a yoga teacher who was overly compassionate only made me feel more like an invalid, rather than on my way to health and recovery. I found hope and well-being in being treated as “normal,” without coddling or denial.

I hear the same from my students. They get treated as patients by their doctor, nurses, family, and friends. Having to reconnect with that feeling is not why survivors come to yoga class. Learn the facts about cancer and appreciate that true compassion flows from knowledge and facts, not just feelings.

Cancer Is the Real Teacher

Some survivors will not make it, and a yoga teacher must be prepared to face that reality. I believe that living with fear makes me a warrior. It is the first lesson cancer teaches a survivor: having to be prepared for the uncertainty of a whole new life. For someone with a life-threatening diagnosis, practicing Savasana, the final resting pose, is no longer an abstraction. It is part of daily life.

I believe this is the biggest difference in teaching yoga to cancer survivors. A life-threatening illness can help us all learn how to live fearlessly. If faced directly, cancer is everyone’s teacher.

Learn more about getting the training you need from Tari and yoga4cancer.  Click here for details and schedules.

Navigating Cancerland with Yoga – by Tari Prinster

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 received the Yoga Journal ‘Seva Award’ in 2015

Tari Interview on Beyond50 Radio Program

Tari’s Interview on ‘Write the Book’ Podcast

Tari was interviewed by Shelagh Connor Shapiro for the ‘Write the Book Podcast’ on January 19, 2015 about Yoga for Cancer.

Healthmonitor – Guide to Chemotherapy

Tari and yoga4cancer has been featured Guide to Chemotherapy by Healthmonitor that can be found in most doctors offices and cancer care centers.  Tari talks through her recommended poses to beat stress & fatigue and improve flexibility & bone mass.  For a copy please download here. Tari & y4c in Healthmonitor or for online content click here.

yoga4cancer featured in Classtivity blog!

There’s no greater feeling than taking an unmistakably negative situation and turning it into an empowering, positively life-changing one. Since October is National Breast Cancer Awareness Month, we want to introduce you to Yoga 4 Cancer‘s Tari Prinster, who has dedicated her time to help cancer patients and survivors feel whole again. …
(read more at Classtivity.com)

YogaCity hunts down NYC’s best classes – Lauren Tepper for Yoga Sleuth

Yoga 4 Cancer (Y4C) ® classes were created by cancer survivor Tari Prinster. This is not a generic gentle yoga class; it is specifically designed for women struggling with cancer, applying yogic remedies to common issues including fatigue, weakened immune system, and limited range of motion or discomfort due to surgeries. In today’s class with Mimi Ferraro at Maha Padma Yoga Temple (formerly Bija Yoga), Sleuth discovered a warm and compassionate community, and a physical practice that was actually more challenging than I had expected. …
(read more at YogaCity)

Empowerment through Yoga for Breast-Cancer Patients

If you’ve seen a copy of the October 2012 issue of “Yoga Journal” magazine, perhaps you noticed the “Staying Strong” story about Tari Prinster who “found personal empowerment through yoga” after her breast-cancer diagnosis. … by Penny Powell, RYT-200, Life’s Journey Yoga & Wellness Center
(read more at Life’s Journey Yoga & Wellness Center)

Tari Prinster highlighted in People section of Yoga Journal, October 2012

Staying Strong – Diagnosed with cancer, Tari Prinster found personal empowerment through yoga… (view article)

Yoga Women article with a spotlight on Tari Prinster in Organic Spa Magazine

“Maybe society isn’t used to seeing a near 70-year-old woman stand on her head. But it sure is fun,” says Tari Prinster, who teaches a class for cancer survivors at New York City’s Om Yoga Studio… (read more at Organic Spa Magazine)

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Tari Prinster, a yoga instructor at the OM Yoga Center on Broadway, is targeting her classes to a very specific clientele: breast cancer survivors…(read more at Washington Square News)

Interview | Tari Prinster on Surviving Cancer, Teaching Yoga, & Changing Lives

Tari Prinster doesn’t look like a woman who would let anything stand in her way.

She has a shock of bright red air, a lithe and strong body with killer arms, and broad smile that brightens any room. But 11 years ago, Tari was sidelined, with Stage 3 Invasive Ductal Carcinoma, an invasive breast cancer…(read more at Yoganonymous)

Union Square class gives hope to breast cancer survivors

Union Square — About a dozen women stretch out on their yoga mats at a studio near Union Square, waiting for class to begin. Some lie back and breathe deeply in a meditative state, while others chat quietly, catching up with friends…(read more at DNAinfo)

Movie Review: ‘Yogawoman’ Explores a Powerful, Quiet Revolution

Movie Review: ‘Yogawoman’ Explores a Powerful, Quiet Revolution
Produced by the husband-and-wife team Kate Clere McIntyre and Michael McIntyre, the new documentary Yogawoman is far more than the flexible poses it depicts… (read more at Bust Magazine)

Turning Point: Tari Prinster

Tari Prinster considers herself a living testimony that it’s never too late to change. Through yoga, Tari has found not only a way to reduce pain, strengthen her immune system, feel younger, stay healthy, and manage the stress of life… (read more at Kripalu)

Teaching Yoga to Someone with Cancer

At first glance, the idea of yoga for cancer patients undergoing treatment and now in survivorship seems obvious, a logical step… (read more at OM)

WCBS-2 Feb. 25, 2011 in New York

How yoga can help with the side effects of cancer…
(view here at WCBS)

Yoganonamous Interview with Tari Prinster on Surviving Cancer, Teaching Yoga & Changing lives

November 2011 by Amanda Taylor

Tari Prinster doesn’t look like a woman who would let anything stand in her way.

She has a shock of bright red air, a lithe and strong body with killer arms, and broad smile that brightens any room. But 11 years ago, Tari was sidelined, with Stage 3 Invasive Ductal Carcinoma, an invasive breast cancer.

“No matter what kind or stage, cancer steals the breath, clouds the brain, and weakens the body.,” Tari says. “The word cancer pried loose my hold on life and time seemed to stop.” And stop it did… seven months of treatment including three surgeries, chemo and radiation, not to mention unthinkable decisions for herself, her husband and children. There were also side effects, medications, expenses, insurance forms, phone calls, and empty hours waiting for test results—all floating past like debris on a sea of uncertainty and anxiety.  ” My life stopped really, until I took the next breath as a cancer survivor.,” she says. “Since then, nothing has been the same.”

Nothing has been the same for Tari, or, thankfully, for other women living with cancer whose lives Tari has touched. Two weeks after her last surgery she was given her doctor’s permission to return to yoga. Before her cancer she had been into yoga for “vanity,” the workout and how it made her look. After cancer it was totally different. ”What interested me was not what I could not do but what I could do,” Tari says.

“I discovered things that I would have missed pre cancer. I learned to appreciate the ability to breathe. I could not take a really deep breath expanding the ribs, stretching the incisions around the surgical staples. But I was breathing mindfully, enjoying it—and I was doing my yoga. The idea of active, intentional rest was new to me, an opportunity to stop trying to be so athletic and to appreciate simple relaxation.”

During seven months of chemotherapy, Tari’s daily practice varied in frequency, duration and intensity as the challenges of her recovery unfolded. Her yoga practice became her personal tool for survival. And with that realization Tari also discovered her life’s purpose, to create a yoga class for women living with cancer who also wanted to move, to heal and to find community.

In 2003, Tari began teaching her Yoga for Cancer Survivors” class at OM Yoga. The class started with 2-4 women dropping by every week and quickly grew to classes of 20 and 30. A second weekday class was added, and Tari realized she needed more teachers to cover the demand. So in 2005, she began to offer Teacher Trainings at OM. These teacher trainings were the first specifically designed to address the needs of cancer survivors offered in New York City. The program has trained over 400 yoga teachers from all over the world. The weekly classes touch the lives of as many as 40 women a week ranging in ages from 24 to 80. Women with other cancers like, lung, pancreatic, brain and even eye cancers have used the classes to find a way back to feeling normal.