It's Flu Season - Want to Boost Your Immune System?

We're in the midst of flu season. Just how many news features have you seen on H1N1 virus? How many conversations with friends and neighbors? How many FaceBook updates about the flu?

There are two things you can do to give your immune system a little boost (and these are really good reminders as we head into the holiday season): exercise and relax.

Moderate exercise is linked with a boost to the immune system. The boost is short-term; it may only last for a few hours after exercise.

In the cancer field, we've known for a few years now that exercise can help boost the immune system of people going through chemotherapy. Studies have shown that moderate exercise reduces the number of infections and hospitalizations during treatment, as well as improving the rate of adherence to treatment protocol. And a study by Andrea Mastro, of Penn State University, and colleagues, which was published in Medicine & Science in Sports & Exercise, found that regular moderate exercise helps the immune system of patients undergoing chemo to bounce back faster after chemo is finished.

Well, what's good for cancer patients is also good for everyone else. According to MedlinePlus, which is an online service of the US National Library of Medicine and the National Institutes of Health, it may not be clear exactly how exercise boosts the immune system. But they have a few theories:
*Physical activity may help by flushing bacteria out from the lungs (thus decreasing the chance of a cold, flu, or other airborne illness) and may flush out cancer-causing cells (carcinogens) by increasing output of wastes, such as urine and sweat.
*Exercise sends antibodies and white blood cells (the body's defense cells) through the body at a quicker rate. As these antibodies or white blood cells circulate more rapidly, they could detect illnesses earlier than they might normally. The increased rate of circulating blood may also trigger the release of hormones that "warn" immune cells of intruding bacteria or viruses.
*The temporary rise in body temperature may inhibit bacterial growth, allowing the body to fight the infection more effectively. (This is similar to what happens when the body has a fever.)
*Exercise slows down the release of stress-related hormones. Stress increases the chance of illness, so physical activity could reverse this factor.
(You can read the whole MedlinePlus article that this is from by clicking here. And MedlinePlus is an excellent resource for medical and health information, for those of you who are not familiar with it!)

This may seem counter-intuitive. It might seem like the best option is to rest if you are concerned about your immune system. But it turns out that the best thing might just be to get moving.

The key, as with so many things, is moderation. Very intense and extended exercise actually lowers your immunity. That's why endurance athletes are often quite susceptible to cold and flu after a major endurance race.

Another key factor in immunity is stress. Stress has been shown to lower immunity and make us more susceptible to colds and flu. This is clearly important as we head toward the holidays - which should be fun, but let's face it, are often stressful.

So try to take a few minutes each day to relax - whatever way works for you. Take a quiet bath after the kids have gone to bed, sit quietly in your car for 5 minutes before heading in to work, turn off your phone and computer for just 10 minutes (probably the world will not actually end if you do).

Or go for a walk. That way, you'll relax and get a little moderate exercise.

Julie

Thankful

I've just returned home from Thanksgiving dinner with friends. I'm full of good food and wine, enjoyed good company, and am ready to toddle off to bed. But first, I want to add my thoughts of gratitude to the many that have already been expressed today.

I am grateful for family and friends who have supported me through dark times and celebrated with me in joyous times. I am grateful for sacrifices made by many which have benefited me. I am grateful for food, beautiful woods to walk in, and the ability to enjoy both of those things. I am grateful for bacon (OK, those of you who know me realize that I really mean this - life is just better with bacon!). I am grateful for 8 years NED (no evidence of disease)!!! And I am grateful for all of the people I have met through this blog and through Life-Cise - you have all touched my heart, thank you.

In short, I am thankful for life. I am simply grateful.Julie

My Opinion, For Whatever That's Worth

I'm going to weigh in on the great mammogram debate - at least it should be the great mammogram debate! OK, I've been weighing in: on FaceBook, on Twitter, in endless conversations all week.

For any of you in the U.S. who might have missed it (??!!?), the U.S. Preventive Services Task Force announced new mammogram recommendations last week, published in Annals of Internal Medicine. They recommend that screening should begin at age 50, rather than 40, and be done every two years. They also suggest that doctors should stop teaching their patients how to do Breast Self Exams.

To be clear, they are talking about routine mammograms, not diagnostic mammograms. If you or your doctor notices an irregularity, or if you have a strong family history of cancer, your doctor could choose to send you for screening if you are younger than 50.

And, these recommendations are not policy changes. Health and Human Services Secretary Kathleen Sebelius was quick to point out that no policy has changed. This is simply the panel's opinion based on their analysis of numerous US and international studies. This is, however, a panel who's recommendations are often looked to by the insurance industry.

There has been growing concern over false positive or inconclusive mammogram results that can lead to anxiety and unnecessary follow-up procedures. Related to this is worry about potential over-treatment of non-invasive cancers that might never become a serious health threat. Many non-invasive, or in situ cancers would never progress to invasive cancer. So in recent years, there has been much discussion of whether we are over-treating women with DCIS (ductal carcinoma in situ), putting them through difficult surgeries and treatments for a disease that would never threaten their lives.

The panel did find there is benefit to screening women age 40-49. The panel found that 1-2 breast cancer deaths would be averted annually per 1000 women screened if screening begins at age 40, compared with 50.

According to the Breast Cancer Surveillance Consortium, which is funded by the National Cancer Institute, last year there were approximately 135,000 mammograms given for women under age 50. (This is very approximate, the BCSC only provided a bar graph which I found a little hard to read.) So, if I'm figuring the math and understanding the statistics correctly, 135 to 270 young women's lives were saved.

The panel's opinion is that 135-270 women (actual women, not just statistics - your sister, your daughter, YOU) is insignificant compared to the cost in unnecessary procedures and anxiety.

I am the 1 life saved per 1000 screened. If these recommendations were in place in 2001, I would certainly be dead. My cancer was found during a routine self exam. The initial diagnosis was DCIS, but surgery revealed that I actually had two moderate, aggressive invasive cancers. Overnight, I went from stage 0 to stage 3 breast cancer. I would never have made it to age 50 for my first mammogram, as recommended by this task force.

In the New York City area, private insurance payments for mammograms are currently around $180. So, for my group of 1000 women screened, that is a cost of less than $180,000 in 2001, the year I was diagnosed. (for ease of argument, lets use $180,000 - I'm tired to looking up statistics and don't want to track down what mammos cost in 2001) But because $180,000 was spent on mammos., my breast cancer death was averted. If I live another 50 years from that year (reasonable, that would put me at 87), I estimate that between taxes paid and money spent on everything from food to charitable contributions, I could easily contribute over $2,000,000 to this country's economy.

That's just my monetary contribution (and very approximate). I also like to think that my life is intrinsically worthwhile - I could be wrong about this. I play music, but there are lots of good violists around; I could easily be replaced. I founded Life-Cise because I felt I had something to offer that could really help others who face a cancer diagnosis and treatment. Generally, I try to be a good person; help people when I can. But how valuable any of this is is debatable.

So the question is, is my contribution to the world worth the cost in dollars and stress caused by unnecessary procedures? Selfishly, I happen to think that my contribution is worth the cost of some mammograms. I happen to believe that the number of women saved by mammograms is not insignificant.

As much as I disagree with the conclusions of the USPS Task Force, I actually believe it is reasonable to raise the questions, however. Asking the questions is not "rationing" of health care. In reality, rationing happens all the time. Choices of what treatment is appropriate and available to us are made by out doctors, their hospitals, INSURANCE COMPANIES, and even our own finances. Costs of care and issues of the length or quality of life are really tough issues for all of us to sort out. They're tough issues, but they need to be discussed. We should all enter this dialogue with our doctors, our families, our friends, and our communities.

Mammograms are not without flaws. They do sometimes detect abnormalities that are harmless, but this leads to further tests. And being called back in for follow-up or biopsies does cause understandable anxiety!

Because younger women's breast tissue is denser, mammograms are less effective for them. Because of this, younger women tend to have more suspicious readings, which lead to more procedures.

Mammograms are an imperfect tool. I just don't believe that the proper response it to take away the only real tool we have because it's not perfect. I wish instead, that a discussion of the problems with mammograms would lead to a real call to action. Mammogram is a flawed tool - GIVE US A BETTER TOOL FOR DETECTION! If women are being over-treated for disease that would never become life-threatening - GIVE US BETTER TOOLS FOR DETECTION! If you think this is all too stressful for women to bear - GIVE US A BETTER TOOL!

Julie

My Back Hurts - That Would Be Serratus Posterior

OK, I was out hauling in firewood this morning. I reached over and, boom, my back seized up. It wasn't even a big piece of wood, just a little thing - so annoying! I came in laid down on the floor and took some nice deep breaths.

My SCM (sternocleidomastoideus) has been super tight lately - that's the muscle at the top of the neck that turns your head. And all of a sudden, I felt like a band had tightened around the bottom of my ribs - that would be serratus posterior inferior.

(Look, I'm a fitness professional. I'm not going to just say "my back hurts." I've studied anatomy. If I don't know which muscle it is, you can bet I'm going to get out my anatomy coloring book and look it up. I want to know which muscle, how it interacts with other muscles, and where it attaches. But then, I am something of a fitness geek.)

Now, the usual reaction to back pain is to take a pill and go to bed. Not for me. I decided to go for a run. I'm a pretty slow runner anyway, but today I was in serious turtle-mode! I ambled along, slow and awkward (and probably a little crooked). My ego cringed a little when I ran past the road crew like that. Not that any of those fat old guys care, but we're talking about ego.

I ran about 5 miles, and I feel much better. I can breathe more easily. I don't feel like my back is going to shatter into a hundred pieces if I pick up a glass. It's still a little tight, but manageable. And I'm mobile.

I wrote about the idea of exercising for back pain last March, after a back moment on a ski trip. My strong belief is that for most back pain, a little exercise should be your first step, not the bath or bed. It can help loosen up those stiff muscles that are in spasm.

This is totally unscientific; it's just my experience. But I do have experience. Many of you don't know that before I was diagnosed with breast cancer, I had a serious injury. I was run down by a taxi while crossing the street. (I know, I had some serious bad luck, health-wise, for a minute.)

I had a cervical spine injury resulting in lots of pain and physical limits. I learned that the best thing I could do was keep moving. It might not be easy or feel great, but if I did nothing I only got worse. If I just rested, the muscles simply tightened up and I would be less mobile and in more pain.

And I don't like pain!

What I learned from that accident served me well when I was going through cancer treatments. I knew that if I could just keep moving I'd feel a little better. - And from that was born Life-Cise and this blog.

So next time you have a little back pain, instead of just climbing in bed, try a walk or a swim - or even a run.

Julie

More On Getting Started - For Breast Cancer Survivors

To follow along with my recent theme of getting started with an exercise program, I want to give a few extra tips for breast cancer survivors.

The very first thing is to think about your bra. After breast cancer surgery it is so important to have a good, comfortable, and supportive bra for exercising. You've got incisions and scar tissue; you need good support. This really makes a difference - if you don't have one, spend the money and get one!

A lot of women like to wear two sports bras, especially if they're starting to run. I never did that because I didn't run back then (I know, how weird is it that with all the sports I do, I only started running a couple of years ago?). But I know several women who swear by it.

Second, take measurements of your arm before you start exercising. That way, you have a record, and can easily see if you're having any early signs of lymphedema.

And finally, whatever it is you like to do to get moving, do it! Numerous studies have shown a strong association between exercise and a lowered risk of recurrence - as much as 50% in the Nurses' Study.

So, if you used to exercise but fell away from it after surgery or during treatment, get back to it! If you've never been very active, now is a perfect time to start!

Julie

So You Started, Now What?

Alright, you got started! In spite of feeling exhausted from cancer treatments, being weakened by some other illness or injury, simply too overwhelmed by your life to exercise, or being really out of shape because you haven't gotten off the couch for three months, you took the advice and decided to start exercising. You found activities you enjoy, and you've figured out a good, appropriate level for you. Bravo!

So, what's next?

Figuring out how to progress can be tricky. I'm hoping you're enjoying yourself and feeling enthused. But a fairly common mistake comes from enthusiasm. Sometimes people make the mistake of ramping up their workout too much, too quickly. People find that what felt hard the first day starts feeling easier after a few more days. They're tempted to increase their workout right away. - I'm really enjoying this. I feel good; I'm sleeping better; I have a little more energy; yea! What I thought would be tough turns out to be fun. So if I feel good with this, I bet I'll feel great if I do twice as much!

The problem is, if you increase too much too quickly, you're risking injury because your muscles may not be strong enough.

Our workout may begin to feel easy after just a few days mainly because our bodies are learning to do the exercise better and more efficiently, not because we've really built up the muscle. Our bodies and our brains are adapting to the exercise. So if we increase too quickly, we may not have actually built up the muscles yet to handle the extra work.

It's a good idea to stick with your workout for a week or two before increasing. That gives your muscles a chance to really catch up. And by doing that, you will reduce your risk of injury because you won't be over-stressing muscles before they're ready.

And when you are ready to begin increasing your workout, do it gradually and once again, give your muscles a chance to adjust to the new level.

You can increase the duration, intensity, or frequency of your workout. But only increase one element at a time! If you started out with just a short amount of time, try increasing the duration first. Try increasing the time by 10% - if you walked slowly for 20 minutes, walk slowly for 22 minutes. After you adjust to that, try keeping the time the same, but increase the intensity - stick with 22 minutes, but walk a little faster. And after that, maybe add another day of exercise into your week - if you start by walking 3 days per week, increase it to 4.

This holds true for weight training, too.

The important thing is to increase only one element at a time, and do it incrementally. Don't suddenly double the amount of time and the intensity at the same time.

This is especially important when you're just starting out. If you've been inactive, you're body will take some time to adjust to the new stimulus.

So enjoy what you're doing; just be prudent about how you build from here. And again, bravo to you for getting started!

Julie