survivor

The Metaphor of "Fighting" Cancer

This is a repost of something I wrote last year and it is still so much in my mind and heart.

I have started 5 new posts in the past few weeks but somehow haven't been ready to finish any of them. And then today a dear friend sent me Having Cancer is Not a Fight or a Battle written by Kate Granger for the Guardian. The use of fighting language for people with cancer has long been a pet peeve of mine so here I go – hopefully not too much of a rant.

He "lost his battle to cancer". She "put up a valiant fight". We know these words. But why do we use this language? Is it useful? I am sure it's not. I told my friends that these words best not appear in my obituary or I would come back to haunt them.

There is no doubt that living with cancer – or with any acute, chronic or life-threatening illness – asks a lot of us. We want to be able to dig down and find the courage to face some unbelievably sad, painful or simply awful circumstances. We want to push our feelings aside so we can do what needs to be done and keep going. We want to keep the people around us from being discouraged, weepy or anxious (even when we are). Unfortunately, the reality of our circumstances do not truly lend themselves to the mantras of "fight" or "be positive".

We live in a world that seems to divide life between good and evil, right and wrong, friend and enemy. But this is a false dichotomy that just helps us feel better about the side we think we are on. We all too often forget that the other "side" is just a mirror of our own shortcomings, biases, etc. So, too, with unwanted illness: It is not an either/or proposition, but a nuanced and complex journey.

It cannot be useful for us to reject a part of ourselves – whether our own cancer cells or our own feelings. I am convinced that the true challenge is to embrace all of our experience. We need to accept the reality of our illness and to be open to what that means – even if it suggests death is near. We also need to accept that we can thrive now: We can take active steps for our physical, mental and emotional health. No outcome on a date certain can be guaranteed – no matter what anyone says.

Our task is to embrace all that is here – wanting it to be different while recognizing what is present now. The feelings that arise (fear, anxiety, sadness) and the ones we may need to cultivate at the same time (gratitude, love, safety).

I know the size of this task first-hand. And perhaps, because I am an optimist by nature, what I have to say may not be of use to you. But even as I want to make lemonade from lemons, I have struggled not get lost in a pity party, feelings of despair, and such.

Breathe2Change is all about the how of helping you find your path to be present with what is now – even the unwanted stuff – and open to gratitude and possibility and fullness in this moment. And as I support you in your journey of discovery I keep myself connected to the vibrant power of shared connection and the power of the present.

Hope, Fear, & Possibility

 

I have been wanting to write this ever since I wrote an earlier post on The Metaphor of "Fighting" Cancer. I suspect my reluctance comes from anticipating some pretty negative comments, but here are my thoughts. I would love to hear yours.

Hope: To want something to happen or be true and think that it could happen or be true; to desire with expectation of obtainment; to cherish a desire with anticipation
(Merriam-Webster Dictionary)

When I hear people (especially those with chronic and life-threatening illness) use the word "hope", I frequently hear unspoken fear. What is hope truly? It is wanting things to be different from how they are now. There is nothing intrinsically wrong with this: change is always happening. And when we find ourselves in a challenging or difficult situation, it is natural to want relief or improvement.

But at the same time, when we spend our psychic energy "hoping", we distract ourselves from the present and miss the richness that is already here now. And this takes not only mental and sometimes physical energy but it often brings with it a kind of denial. Can we have hope and truly see and accept things as they are now? I am not sure.

When I faced the death of my husband and then the possibility of my own death many years ago, I changed my framework for thinking about this. It became important for me to acknowledge and embrace the present and all that it contained – including the physical and psychological pain as well as the prognosis that the doctors offered. At the same time, I recognized that these were just numbers and statistics and that anything was possible. And it was this combination of welcoming what is here now and holding space for the entire range of possibility that has served me well.

I make space for both the known and the vast range of unknown. For me that known included the nausea, fatigue, and pain as well as the deep intimacy with family and friends, allowing myself to be dependent and accept an abundance of assistance. For me that unknown included both the possibility of death as well as the ability to survive and thrive. Hope has not been in my vocabulary. I refuse to attach my sense of well-being to something that is not here now and simply not knowable.

I understand this runs counter to so much of contemporary culture, especially in the cancer survivor world. I welcome your thoughts.

The Yoga Therapist & Cancer Care: Special Cautions

The health status of a person with cancer can change frequently, particularly for those in active treatment, so it is critical to assess and reassess at each visit. The cautions that follow are not intended to be an exhaustive list but a starting place for you. These are some critical issues faced by people with cancer that impact health and safety when doing yoga.

• Cancer affects the immune status of patients, making them more vulnerable to illness and infection. It is important that the space you use as well as mats and props are clean before anyone with a compromised immune status uses them. I encourage clients in this situation to bring a clean sheet or blanket from home to put under them so they do not have direct body contact with the floor. Encourage students in a therapeutic class who have any symptoms of cold, fever, flu, or any other active infectious condition either not to come to class or to create as much physical distance as possible between them and anyone with low immunity. Remember, cancer patients’ immune status can fluctuate wildly from week to week.

• Along with compromised immunity, people undergoing treatment can have low blood platelet counts (which can lead to bruising and bleeding). Avoid props and ties that apply direct pressure to the skin because they can cause bleeding depending on how they are used.

• People undergoing treatment (and sometimes people with more advanced disease who are not having treatment) will often have a port or central line. These are devices placed in the chest so that drugs can be delivered directly into a vein. This is done to reduce insertion of needles into the hands and arms and to reduce inflammation that certain drugs can cause in the peripheral veins of the extremities. These devices can remain in for months. Some doctors advise their patients that there are limitations on certain physical movement if you have one of these central lines or ports. The typical limitation that is related to yoga is to avoid placing the head beneath the heart—no inversions, standing forward bends, and so on, including downward-facing dog pose. On the other hand, some physicians say there are no restrictions. It is important that your client/student understand their doctor’s directions. If the client doesn’t know, always err on the side of caution.

• Cancer can often spread, or metastasize, from its original site to other organs (including the bones). A client may or may not know if they have cancer in their bones or if their disease has spread to another site (metastatic, or Stage IV, cancer). If they do have metastatic disease, check with them about whether their type of cancer can spread to the bones (they may not know). If they have any tumors in their bones, you’ll want to know where. Also, bones may be radiated as part of treatment. If so, the client may be vulnerable to fractures—typically in the spine, pelvis, or ribs—because the bone is weakened and no longer has structural integrity. So avoid anything that stresses the bones: bound or closed poses, anything that uses leverage or torque (e.g., seated twist, bound triangle, bound side angle, and most hand-to-bigtoe variations). There can be situations where the bones are so weakened that anything that stresses the spine in extension or flexion can be risky. As above, this is dependent on the individual. When in doubt, I make the practice extraordinarily gentle until there is some medical guidance.

• If your client/student has a known tumor present, he/she should avoid putting direct pressure on the tumor. Clients often have discomfort in the area of the tumor, and that can be self-limiting. For instance, prone poses such as cobra can be a problem for people with pelvic or abdominal tumors.

• Some clients will be taking steroids. Steroids can cause mood shifts (often depression), weight gain, and physical and/or mental agitation so that it is hard to stay focused on anything and/or to keep the body still. Sleep is often disrupted or very difficult. In addition, steroids use can result in being immune compromised, so use the same precautions described above.

Lymphedema is a condition that arises from removal of lymph nodes, resulting in fluid accumulation (typically in the arms or legs) because the lymph drainage system is no longer working correctly. Most often this condition is seen in breast cancer patients, but it is not limited to them. This condition can vary greatly from patient to patient, but generally, avoid long holds of poses that extend the impacted limb overhead. It is best to move in and out of such a pose briefly and avoid stays. Also avoid direct weight bearing on the affected limb. Because of the variability of this condition, it is best to consult with the client’s physical therapist. One last point on this condition, sometimes you the teacher or therapist may notice that a part of a limb looks swollen. If so, ask the client/student about this and make sure they are getting appropriate medical treatment. Lymphedema left untreated can be quite serious and is sometimes unnoticed by the client. This condition can also occur a long time after treatment has ended.

Conclusion
Working with people with cancer can appear overwhelming, and as I write this I am reminded of the remarkable complexity involved. But that said, begin with yourself: are you interested in this work? Do you have the training and support you need? If the answer to these questions is affirmative, then an amazing world may open up for you. People with cancer are often ready and available for work at each level of the panca mayas (koshas), and profound change is possible. I love this work. Perhaps surprisingly, it is not draining and in fact feels mutually nourishing. If you want to know more, you can contact me directly.

This article was first published in Yoga Therapy Today (a publication of the International Association of Yoga Therapists).

Thanks to Olga Kabel at SequenceWiz and @SequenceWiz for republishing sections of this article on her guest blog.