After Tasgirl’s latest comment/question (see comments for PET/CT Scan) I find it necessary to write this post. One of my motivations for this blog is to let other chemo patients know about the benefits of exercising and endurance training during chemotherapy. There are a lot of research studies that show exercise is one of the best things one can do during chemotherapy, unless they have cardiac disease or some other serious health issue. The old adage that one should rest and conserve energy during chemo therapy is a bunch of hooey. I’ve recently came across an article about a study that looked at two groups of elderly (70+ years) persons. One group was actively in running clubs (some probably running marathons) and the other group was not. They found that the group in the running clubs were far healthier and had much fewer problems with joint pain and the alike. As long as running is done right, it only makes you better. However, there are no studies, no manuals, no books, no papers, very little about marathon training during chemo. This is uncharted territory.
I have run into a couple of websites about people who have trained for a marathon during chemo. But I haven’t seen any scientific study that shows marathon training is good or bad during chemotherapy. All I know is pretty much my own experience.
I didn’t tell my oncologist right away that I was training for a marathon. During each of our visits when he asked how I was doing, I always told him how far I ran that particular week and my long runs. So he heard I was running 30 to 40 miles a week and 12 to 16 miles for a long run. But I was afraid to tell him I was training for a marathon. If he said he didn’t want me to do it I probably would have stopped. I did tell my oncologist’s nurse practitioner, who happened to be a marathoner. She said, “That’s great, go for it!” or something like that. Then about a couple of months before the marathon and I think when they decided I didn’t need anymore chemo treatments, I was telling my oncologist that I ran something like 18 miles on Sunday and he looked at me with eyes of disapproval and asked, “are you training for a marathon?” I said yes and he was ok with it, but I think he didn’t like the fact that I withheld that information from him. I don’t blame him. But he couldn’t deny the fact that I was probably healthier than most normal people and the running had a lot to do with it.
During chemotherapy I did not feel any adverse affects from running. I did not get more injuries than I would normally get when pushing hard. I was mostly careful with my training. Because of anemia I had to slow my running way down, otherwise my heart rate would go too high. I was careful to keep my heart rate in a good range for long distance running. I did have a problem with a foot injury, but I don’t think that had anything to do with chemo. I just fell behind in my training and I tried too hard to catch up. After seeing a podiatrist and using some shoe inserts the injury went away and I was running Grandma’s marathon very healthy. I ran about 425 miles during chemo and finished Grandma’s in the top 42% of all runners, including the young bucks. Later last year I ran the TC marathon and finished as healthy as a horse. My doctors are amazed at how well I have handled (both emotionally and physically) chemotherapy and how quickly my tumors have disappeared. Marathon training during chemotherapy didn’t cause extra damage to my body, but just the opposite, it reversed the damaging effects of chemo.
At this time there is no scientific evidence that shows marathon training is good or bad during chemotherapy. Many doctors may frown on the idea. But I truly believe that if one does marathon training the way it should be done, by slowly increasing distance without pushing the body too hard, and listens to their body for signs of stress, that any endurance training like marathon training is one of the best things you can do during chemotherapy. Everyone is different and this does not apply well to everyone. But I don’t believe you have to be a super athlete to do this. I’m far from a super athlete; I’m just a Regular Joe who likes to run. It’s really more about attitude.
Click on the following link to read a wonderful true story of a group of ordinary men and women who train and run a marathon. http://www.pbs.org/wgbh/nova/marathon/team.html
NOVA takes 13 individuals who are non-runners, some with serious health issues, trains them for the Boston marathon. Only one of them doesn’t start or complete the race because of bone stress fractures which were a result of type-I diabetes. There are some very inspirational stories in this NOVA story.
If you are planning on marathon training during chemotherapy, don’t expect doctors to agree with you. You’ll probably be discouraged to do it. Then you’ll have to decide if you’ll go against your doctor’s wishes or not. I truly believe that I was doing the right thing. What do you believe?
Saturday, February 21, 2009
Thursday, February 12, 2009
PET Scans, Diets, and Mountain Training
Well I have some fabulous, fantastic, super, wonderful, amazing, awesome, tremendous, astounding, splendid, breathtaking, great, extraordinary, remarkable, magnificent, huge, enormous, very big, terrific, superb, marvelous, brilliant, spectacular, astonishing, good news. My PET scan came back squeaky clean again. My Oncologist is very impressed. In the past when asked about how he felt about his pathologist’s diagnosis (a curable type of lymphoma,) and Mayo’s diagnosis (an incurable type), he refused to give any speculation and just concluded it was a difference in opinion and there’s not much we can do about it. But now he is thinking a little differently. He still talks with great care. He is a well seasoned oncologist and knows how to talk to the patients without scientific backgrounds. I’m working on him to communicate in my language - science, math and probabilities. These are not the exact words he said, but rather my interpretation.
Being a seasoned oncologist, he has seen many cases of both types of lymphoma: diffused large B-cell (DLBC) and follicular. He has seen how patients of each type respond to chemo and that, on the average, there is big difference in response characteristics. I speculate that many more DLBC patients have rapid and complete responses than follicular patients. It may be rare that follicular patients have a complete remission that lasts any period of time. Therefore, since my response has gone so well and so complete, the probability that I have follicular lymphoma (incurable type) is low and it is much more probable that I have DLBC. We will never know for sure, but the more time I stay in complete remission, the more probable I have been cured.
Getting through the first year in complete remission is a huge milestone. At the one year milestone my odds of surviving and being cured are much greater than 50/50 odds I got just before starting chemo. (I intend to calculate those odds based scientific papers I found on the internet, but I’ve been too busy enjoying life). The first year milestone is the biggest for burning down risk, but the second year is a big one too. However, it doesn’t matter what happens here on out. I’m very gratified with the extension of life I’ve received thus far. From here on out, it’s icing on the cake.
Even though my diet and my training have not gone exactly to plan, my weight loss has. During the work week I do a pretty good job of staying under 2000 calories a day. But I haven’t been able to count my calories close enough to record them. It’s easy to measure food when I’m home, but whenever we dine out or eat at someone else’s house or when I’m on a business trip, I just have to estimate how many calories I eat. And I don’t always count them either. I have been traveling to Phoenix on business trips for the last couple of weeks, but that is a good thing when it comes to my diet. For business travel I don’t dine out but rather get a hotel suite that has a kitchen and cook my own food. Since I buy all my groceries, I don’t get the tempting treats that my wife gets for our sons. So I actually eat much healthier when I travel on business. I haven’t given up on calorie counting; it is still the basis for my weight loss plan. I’ll still do it when I can and when trying new meals. Many of my meals I already know how much to take to stay within my calorie limits.
Keeping track of my weight every day has also been a learning experience. I’ve noticed that my weight has a big cycle that repeats itself over a one week period. Every weekend my weight goes up 2 or 3 pounds, and then drops during the week.
I think the weekend weight gain is mostly water weight. I speculate that on the weekends I tend to eat foods that are much higher in sodium, which can make the body retain water. So monitoring your weight on a daily basis can drive you crazy if you’re not careful with interpreting the data. The first plot of my weight shows my daily weight over four weeks. The first week I was not on my diet. During the fourth week I was in Phoenix so there is some missing data. You can see my weight being all over the map, but there does appear to be a downward trend too.
Being a seasoned oncologist, he has seen many cases of both types of lymphoma: diffused large B-cell (DLBC) and follicular. He has seen how patients of each type respond to chemo and that, on the average, there is big difference in response characteristics. I speculate that many more DLBC patients have rapid and complete responses than follicular patients. It may be rare that follicular patients have a complete remission that lasts any period of time. Therefore, since my response has gone so well and so complete, the probability that I have follicular lymphoma (incurable type) is low and it is much more probable that I have DLBC. We will never know for sure, but the more time I stay in complete remission, the more probable I have been cured.
Getting through the first year in complete remission is a huge milestone. At the one year milestone my odds of surviving and being cured are much greater than 50/50 odds I got just before starting chemo. (I intend to calculate those odds based scientific papers I found on the internet, but I’ve been too busy enjoying life). The first year milestone is the biggest for burning down risk, but the second year is a big one too. However, it doesn’t matter what happens here on out. I’m very gratified with the extension of life I’ve received thus far. From here on out, it’s icing on the cake.
Even though my diet and my training have not gone exactly to plan, my weight loss has. During the work week I do a pretty good job of staying under 2000 calories a day. But I haven’t been able to count my calories close enough to record them. It’s easy to measure food when I’m home, but whenever we dine out or eat at someone else’s house or when I’m on a business trip, I just have to estimate how many calories I eat. And I don’t always count them either. I have been traveling to Phoenix on business trips for the last couple of weeks, but that is a good thing when it comes to my diet. For business travel I don’t dine out but rather get a hotel suite that has a kitchen and cook my own food. Since I buy all my groceries, I don’t get the tempting treats that my wife gets for our sons. So I actually eat much healthier when I travel on business. I haven’t given up on calorie counting; it is still the basis for my weight loss plan. I’ll still do it when I can and when trying new meals. Many of my meals I already know how much to take to stay within my calorie limits.
Keeping track of my weight every day has also been a learning experience. I’ve noticed that my weight has a big cycle that repeats itself over a one week period. Every weekend my weight goes up 2 or 3 pounds, and then drops during the week.
I think the weekend weight gain is mostly water weight. I speculate that on the weekends I tend to eat foods that are much higher in sodium, which can make the body retain water. So monitoring your weight on a daily basis can drive you crazy if you’re not careful with interpreting the data. The first plot of my weight shows my daily weight over four weeks. The first week I was not on my diet. During the fourth week I was in Phoenix so there is some missing data. You can see my weight being all over the map, but there does appear to be a downward trend too. A better way to look at weight is by averaging the daily weight over a one week period. This takes out the weekly cycle and reduces random variations. As you can see in the second plot the data points fall much closer to the fit line, which shows that I’m losing on the average 1.2 pounds a week (rounded up), slightly better than my goal. 
The fit equation shows a good R^2 factor of 0.98 (rounded up) which means the data follows the fit line to a very high degree. Isn’t science amazing?
My running training has gone very well too, but not always as planned. Over the prior two weeks I have run two half-marathon (13.1 miles) runs. The first one I didn’t have a great finish time of 2:02, a long ways from my goal of 1:39. However, I was running mostly on my local trail which had fresh loose snow on top of ice. The slipperiness robbed energy from every step I took. I was exhausted and beat up near the end of the run and hoping it was due to the slippery conditions. The following week the loose snow had melted and I was mostly running on hard pack snow, in which my trail running shoes get pretty good traction. My finish time was 1:54 and I felt great at the end of the run. My guess is that my time will improve even more just from better traction after the snow and ice disappears this spring.
My weight loss plan included running at least 30 miles a week to burn roughly 3500 calories or more per week. Well that hasn’t worked out to plan either. The biggest deviation comes with business travel to Phoenix. Not because I don’t run, but because I do a different type of run while in the desert. My favorite kind of running is trail running, and my favorite trail running is in the desert, and my favorite desert trail running is up and down a mountain trail. I have read that some marathon coaches feel that hill training can also improve speed or finish times. Well, mountain training must be the best then, right? One of my favorite mountains to run up and down is Shaw Butte in the North Mountain Park of Phoenix. Going up the mountain I try to run as much as I can, but need to take walking breaks at the steepest part. There’s something about running up a mountain that is motivating and makes it easy to push harder than usual.
My favorite part though is running down the backside of Shaw Butte, which is very steep and rocky in places. It’s a type of meditation for me. Any mistake could lead to a serious injury, so one must keep constant and absolute focus on each step. This kind of focus really clears the mind of the daily garbage.
When I mountain trail run my running distances (about 4 miles) are less than the typical 6 miles I run on flat land. So it may seem that I’m burning fewer calories if going just by distance. However, based on time and heart rate, I think I’m burning more calories. There are websites that calculate how much calories you burn for just about any activity, including mountain climbing and mountain biking, but I haven’t seen anything on mountain running.
The fit equation shows a good R^2 factor of 0.98 (rounded up) which means the data follows the fit line to a very high degree. Isn’t science amazing?My running training has gone very well too, but not always as planned. Over the prior two weeks I have run two half-marathon (13.1 miles) runs. The first one I didn’t have a great finish time of 2:02, a long ways from my goal of 1:39. However, I was running mostly on my local trail which had fresh loose snow on top of ice. The slipperiness robbed energy from every step I took. I was exhausted and beat up near the end of the run and hoping it was due to the slippery conditions. The following week the loose snow had melted and I was mostly running on hard pack snow, in which my trail running shoes get pretty good traction. My finish time was 1:54 and I felt great at the end of the run. My guess is that my time will improve even more just from better traction after the snow and ice disappears this spring.
My weight loss plan included running at least 30 miles a week to burn roughly 3500 calories or more per week. Well that hasn’t worked out to plan either. The biggest deviation comes with business travel to Phoenix. Not because I don’t run, but because I do a different type of run while in the desert. My favorite kind of running is trail running, and my favorite trail running is in the desert, and my favorite desert trail running is up and down a mountain trail. I have read that some marathon coaches feel that hill training can also improve speed or finish times. Well, mountain training must be the best then, right? One of my favorite mountains to run up and down is Shaw Butte in the North Mountain Park of Phoenix. Going up the mountain I try to run as much as I can, but need to take walking breaks at the steepest part. There’s something about running up a mountain that is motivating and makes it easy to push harder than usual.
My favorite part though is running down the backside of Shaw Butte, which is very steep and rocky in places. It’s a type of meditation for me. Any mistake could lead to a serious injury, so one must keep constant and absolute focus on each step. This kind of focus really clears the mind of the daily garbage.
When I mountain trail run my running distances (about 4 miles) are less than the typical 6 miles I run on flat land. So it may seem that I’m burning fewer calories if going just by distance. However, based on time and heart rate, I think I’m burning more calories. There are websites that calculate how much calories you burn for just about any activity, including mountain climbing and mountain biking, but I haven’t seen anything on mountain running.
So my diet and running training have not gone exactly how I planned. I actually thought of giving up on my diet method. I’m kind of a perfectionist and have trouble finishing things that don’t go to plan. But this time I listened to the words of Winston Churchill, “never, never, never give up”, and decided to stick to my plan but adapt. I can’t stick to 2000 calories every day because many days I just don’t know how much I’ve eaten. But I keep working on learning how many calories on in each meal. I think it’s important to know what you eat. But that just doesn’t happen overnight. It’s like training for a marathon. You certainly don’t start out perfect; it takes a long time to get into a good routine. You’ll always have some bad days, some that you have control over and some that were self inflected. I think one of the key things to succeeding in anything is to realize that nothing including you is perfect and that perfection is not required to move forward. As long as you never, never, never give up, one step back and two steps forward will get you to your destination every time.
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