Run, Julie, Run - Trying to Make Lemonade

You all know about the Holiday Blizzard of 2010. Well, this blizzard came at a very inopportune time for my marathon training. I wanted to get in one more long run before the race, and just wanted to RUN!

But no, between the holidays and the snow, I'm struggling to get in my workouts.

Maybe I'm just a pollyanna optimist, but I'm determined to make some lemonade out of these lemons! Even the best plans need flexibility. So, I can't run as much as I want, I can still get a lot of exercise. With all the lifting of heavy boxes and moving furniture for our house repairs, I've done a whole lot of squats and lunges. And all the lifting and shoveling snow has been great for my core.

Most of the roads around here are too narrow and the snow piles too high to safely run them. I've taken to doing short runs on my hill where there are few cars and we can all see each other. Up & down, up & down.

With at least a foot and a half of snow and drifts that are thigh deep, I haven't done any running on the trails. But I have gotten the skis out...making lemonade the best I can!

So can you - whatever your plan.

Julie

Are You Strong Enough for Life (or a blizzard)?

We here in the Northeast are still digging out from our holiday blizzard. I know we are not the only people to have ever experienced extreme weather, although you might not realize that from the news coverage. A lot of you in various parts of the country/world have had your own storms to contend with. And happening during the holidays, it meant a lot of people were out traveling (or trying to) in it. I hope you all got to your destinations safely!

I'm sure a lot of you have been putting in some time with a snow shovel. I have. But because we have a major house repair requiring us to move half of our house to the other half, I've also been lifting a lot of heavy boxes and furniture. 

And that's got me thinking about strength training - for everyone, but especially for anyone at higher risk of upper body lymphedema. Sometimes we need to get things done; life demands it. It's better to have the strength to handle whatever the situation is.

In 2001, when I had my mastectomy & full axillary dissection, I was given a lot of advice about avoiding lymphedema. The main advice was to never lift anything heavier than 5lbs., don't carry anything on that side, don't carry a purse on that side, never lift groceries on that side - in other words, don't use that side. As a musician who must use both arms strenuously to play, and must carry around an instrument plus whatever I need for the day (concert clothes & shoes, possibly music stand, water, maybe some food, a book, the newspaper...), I found those restrictions impossible. 

I, like a lot of women back then, decided to test our bodies to see what we really could do. On advice from lymphedema therapists, I started exercising gradually. I was lucky to find some people who had the attitude of "give it a try, but always pay close attention". We discovered that those severe restrictions were not necessary. And, in fact, were somewhat detrimental.

Of course, doctors' thinking on this has largely changed (although I continue to be shocked by some of the things I hear that some doctors are still saying). There have been studies, most notably the study by Kathryn Schmitz at U. Penn., that have found exercise, and specifically weight training, to be beneficial for lymphedema. It just must be a very gradual, progressive program which allows you to build strength but not to over stress the muscles.

By never working to regain or build strength, we end up weak and unable to do many tasks of daily life. We end up at high risk of straining our arms, which is often a strong trigger for lymphedema. Life sometimes demands action from us. We have snow storms, groceries, furniture to move, kids to lift....

With clients, I always stress building the strength (gradually, in a controlled plan!) to handle what we need to do. This is true for anyone, but especially for anyone at risk for lymphedema!

So I encourage you all, again, to work to build enough strength that you won't be undone by a snow storm or your daily life.

And I have had a chance, amidst all the packing/moving/shoveling, to get out and enjoy what the blizzard has brought!

Julie

Peace & Joy

      

Merry Christmas, to those of you who celebrate this holiday. And to everyone, no matter what your religious or cultural background, I wish you Peace and Joy.
        
                   Julie

Lessons from Training - The Plan and Why It's Important

What was I thinking??!! Signing up for my first marathon - a winter trail marathon. Not only will I have to run 26 miles, but it will be in biting cold with snowy/icy trails, and treacherous stream crossings. (And as I learned on my last long run, slipping into the stream when it's 20 degrees is NOT GOOD!)

So, it seems I'm having some doubts. Whatever your goal is, I'm sure you have moments of doubt, too. How do you deal with it?

I go back and think about my plan. I made a solid, if aggressive, training plan to get me to my goal. When I'm feeling nervous, I re-evaluate the plan; think about how I'm progressing; and make any changes necessary. Focusing on the plan - the next few steps - helps me past my doubts.

A few other things I've learned as a newbie trail runner:

*Learn all the skills you need. Learn how to go downhill, too! Most people think running up the hill is the hard part. Well, it is, but it's not the only hard part. Even though going downhill might seem like the easiest task - you just run down - it takes just as much skill as anything else, maybe more. Heading down a rocky hill takes balance, agility, and good control - especially when you're exhausted from steep climbs and your legs feel like jelly!

Start slowly. Build up the balance and coordination on easier hills. Take them slowly - always be in control! Over time, increase your speed and take on steeper hills. But always stay in control. Hurtling down a rocky hill, out of control is a great way to end up injured.

Learn all the skills you need.

*Work on one thing at a time. Don't try to improve everything at once. Break down your goal into all the skills you will need. Concentrate on one skill at a time. You need to learn all the skills, but you'll be more efficient and make more progress if you work on one at a time.

So, this week, I'm working on speed. I had a good long run - 15 miles - which felt pretty comfortable. But now, I'm working on speed. I'm doing shorter runs faster. In past weeks I've concentrated on other skills. I alternate focusing on steep hills, speed, and distance. That way, I really improve that skill in a concentrated, efficient way.

Focus on one thing at a time. It will end up being the most efficient way to improve.

*Be prepared for mishaps. When you stumble - and you will sometime - bad things can happen. Be prepared.

I fell in a stream up to my thighs. It was 20 degrees. That was rough! That was unpleasant! But I did have my cellphone in case I got into any serious trouble. I had my trail map with me so I knew the quickest way to a road. I had extra warm gloves and hat. And I had plenty of water and snacks. I do my best to minimize my risks, but I do acknowledge that what I'm doing does have them.

Most things we do have some risks. Even with our best planning, we're likely to encounter some mishaps along the way. Deal with it. Do your best to prepare, but know that sometime you might just have to suck it up to get through.

But that's what training is about - giving you the skills you need in manageable bites. That's what the plan is about. Then, when you need it - the strength, the endurance, the balance, the speed - will help you through the tough spots.

Julie

Half Of Women Don't Get Mammograms - When Is Yours?

I had my annual mammogram earlier this month - when is yours?

A study presented last week at the San Antonio Breast Cancer Symposium found that only 50% of women 40 and older got annual mammograms. The study looked at 1.5 million women who had continuous insurance coverage. (I posted the results of that study on the Life-Cise News page.)

Those of us who have involuntarily joined the breast cancer community sometimes feel like there's plenty of awareness, especially after the pink parade that is October. I often hear the phrase, "enough with awareness - we need a cure!"

But this study clearly shows there is still a need for more awareness - half of women who have insurance don't get screened. Any awareness campaign, for this or any other disease, must always be a call to action.

Sometimes I think the real message about awareness gets lost in all the pink fluff. Breast cancer awareness is not just about wearing pink, sporting a pink ribbon on your car or cat litter, or playing some silly game with your Facebook status updates. It should be about awareness that this is a disease that kills people. It can destroy lives and dreams and families.

Of course, we deal with the losses: sometimes stoically, sometimes angrily. We go through all our treatments as best we can, and get on with our lives. Most of us go on to live wonderful, fulfilled lives - grateful for each moment.

But never forget that the pink ribbons are a reminder that this is a terrible disease. And the tool we have right now to detect this disease is the mammogram. Mammogram may be an imperfect tool, but it does save lives.

Please don't forget that.

Julie

Run, Julie, Run - Marathon Dreaming

Do you have a goal? Are you working toward something? Whether it's a grand plan or something small, do you have a challenge?

I do.

I'm going to run a marathon. Or, I'm going to try. I've just signed up for a winter trail marathon with NJ Trail Series. The race is Jan. 8. These are the same folks who held the race which was my second half marathon. I did not run that one very well. In fact, I had a really hard time. But I am undaunted!

This is a big step up for me. I have a month and I've been training, but this is kind of scary for me. I've been thinking about this for a while, and training. However, now that I've finally committed - I paid the $20 entry fee yesterday - I'm freaking out a little. That's a long race! And in the middle of the winter.

What was I thinking?

I've been training. I made a plan; I've been sticking pretty closely to it. I have a plan for the next month. I made a plan with reasonable, incremental increases. It all makes perfect sense on paper.

But I'm suddenly overwhelmed with the enormity of the race.

Training is like that - no matter what your goal. If it's a worthy goal, it should be a little a challenge. And challenges are scary. Focusing just on the goal can feel overwhelming sometimes. It's often easier to focus on the smaller steps that are moving you toward that goal.

So yesterday, after I signed up for the race, I hit the trails and ran 5 miles. Today, I didn't have much time, so I ran just 2 miles, but chose a route that was all steep hills. Those were the immediate steps I could do. They were also tasks that I could focus on which were quite manageable (not like thinking about 26 miles and freaking). Wednesday or Thursday, I'll do my next long run. I'm planning on 15 miles, maybe a little more, depending on how I'm feeling.

I have a plan. I have manageable, reasonable steps that will get me ready for my goal.

The way I'm tackling this goal applies to any goal, big or small. Figure out a goal that makes sense for you. Plan the steps you need to take to get you there. Figure out medium-term goals, shorter-term goals, and immediate steps.

It's the same procedure I went through after my mastectomy and free TRAM reconstruction with full axillary node dissection. I had very limited mobility after my surgery, but was determined to continue playing the viola. I worked out the steps I would need to take before picking up the viola. I worked on regaining range of motion. I stretched every day. I then worked on slowly rebuilding strength. And finally I started playing the viola again (and never stopped).

It's the same procedure you need for your fitness goals, too. Whether you're marathon dreaming or just want to be able to shovel the snow when it falls, set your goal and make a plan (and give me a shout if you need help with your plan).

Julie

Good News for Lifting Weights!

More results from the Physical Activity & Lymphedema study were just released. This is the study which found weight lifting beneficial for breast cancer survivors who already had lymphedema. I wrote about the study an August 2009.

Further study has found that lifting weights is good for BC survivors who do not have lymphedema, but are at increased risk. There was no increased development of lymphedema in women who took part in the weight training program compared with those who did not. Interestingly, women at the highest risk for lymphedema - those who had 5 or more lymph nodes removed - had a 70% reduced risk of developing the condition with the weight lifting program. More about the study can be found on the Life-Cise News page.

There are many of us who have been proving this for years by example. I had 14 nodes removed, plus radiation. And I am just one example - there are many. What is key is gradual progression! Never begin with heavy weights. And if you've taken some time off, start again with lighter weights and build gradually.

Get good advice from a trainer with experience with cancer and lymphedema. Don't just jump back into what you did before surgery - you can build back up, but don't start there. Many standard practices in training must be modified for cancer survivors when starting out. This is precisely why I started Life-Cise.com; there was far too little quality information available. And those of you who are clients of mine know that I truly believe in weight training for everyone - but especially for breast cancer survivors!

As the researchers noted, the traditional advice of basically not using the affected arm, has been shown to be quite outdated. Evidence now shows that a deconditioned arm is more likely to suffer injury and strain, thereby increasing the likelihood of lymphedema. Lifting weights, when done properly - with a gradually progressive program - is beneficial for breast cancer survivors with or without lymphedema.

Julie

Lessons from Training - Best Laid Plans of Mice & Men

Today was my long run. I had planned on running 15 miles. (planned being the operative word)

And here are the lessons I learned, most of which I think apply pretty well to cancer treatment.

*Sometimes you need to adjust your plan. Make a plan, but know that circumstances might arise that make an alteration prudent. I had planned on running 15 miles today. It was a modest step up from my 2 recent half marathons. But I got started about 45 minutes later than I had planned. That's 45 minutes of daylight which is precious at this time of year. Also, we had a pretty epic storm a couple days ago which flooded roads and downed trees. Back in the woods, that meant that each little trickle of a stream was a river. Each crossing took extra time to negotiate passage. And it meant not only that all the trails were muddy, but most of them had turned into running brooks.

It was clear that I was going to have trouble running my planned course. I ran the 6 1/2 miles out, but knew my longer return route was not going to be doable. I changed plans and came back the way I came, rather than adding an extra 2 miles with a lot of very steep climbs.

Sometimes you just need to change your plans. It may not be what you want, but reality is what it is. And this definitely applies to treatment. Sometimes, no matter how much to want or need to do something, it's just not the day for it. Accept that. You can still push yourself mightily, but you might have days when you simply can't do all you wanted.

But if you wisely make some adjustments, you may be able to complete the plan tomorrow or next week.

*Learn about proper care & feeding. Food and water - basics of life. Figuring out how often to eat and drink is pretty important. I've learned that I need to have a snack around every 2-3 miles, not much, maybe just a few nuts or square of chocolate - but I need something. And I need water. I sweat - a lot! So I need to replenish my body's fluids. I've started carrying a handheld bottle and a couple of clementines.

Smaller, more frequent meals or snacks are often good. When I was in chemo, I found that to be true. I was less nauseous when I ate small amounts at regular intervals, rather than getting hungrier and trying to eat larger amounts. Not only was it better for my stomach, it also kept my energy level up.

And sometimes, drinking your nutrition is the only way to go. There were times during chemo, as well as climbing at high altitude, that all I could manage was juice or something like Ensure. But that kept me going - it was calories and some nutrients that my body needed.

Figure out what works for you.

*If you're running trails, you're going to get muddy and you're going to get wet. Get used to it. I start out trying to avoid the puddles, hopping from stone to stone. Eventually, I realize that I'm simply going to be wet. And I'm not talking about damp. I'm talking about full on sopping wet - and cold! But it's really just part of the process - no way to avoid it other than not running trails.

I felt the same way sometimes during treatment. After a while, I felt like, yes I'm bald, why talk about it? Yes I feel crappy, but so what - it's chemo! Of course there's a lot to feel bad about. None of us chose to have cancer. It's totally unfair. And all of the treatments suck. But we make our choices about what treatments we will endure. It is a choice. It's a choice that can save our lives - which makes it a good choice (in my opinion). After a while, I just felt like all the negative sides to treatment were part of the process. Like the mud on the trail, the only way to avoid it was to not go through the treatment. And I chose that that was not an option for me.

*Hydrate! I know I put this in all of these posts, but it's important. Drink more than you think you need, before, during, and after. Our bodies need water to function. Without water, our cells die and our organs fail. Drink.

In climbing, we learn to pay attention to the color of our pee. More clear is better, dark yellow is bad. Darker yellow means the body is getting dehydrated. And in climbing, you're may be in a more remote area, days from help. Staying hydrated is serious. People die from dehydration.

This applies to chemo as well. All those drugs tend to dehydrate us. Drink, more than you think you need, before, during, and after.

And keep an eye on your pee. Clearer is what you want, unless you've just had an Adriamycin infusion, in which case you'll be peeing all sorts of weird red & orange colors.

*Watch where you're going; course corrections become harder to deal with the more tired you get. This one's pretty self-explanatory.

Julie

Ideal Body Mass Index Found

A study just published in the New England Journal of Medicine, and posted on the Life-Cise News page, has found that a Body Mass Index (BMI) of 20 - 24.9 is associated with the lowest risk of death from all causes. The large study analyzed data from 19 long-term studies. Researchers found that, after accounting for other health risks, a 31% increase in risk of death was associated with each 5 unit increase in BMI. So, for instance, an obese person with a BMI of 30-34.9 had a 44% higher risk of death. Shockingly, severely obese with a BMI over 40, had a 250% increase! But even modest excess weight made a difference. A BMI of 25-29.9 showed an increased risk of 13%.

A couple days ago I wrote another post about BMI and our perceptions of weight. In it I give the formula for figuring out your BMI (also a link to the National Institutes of Health website for their handy BMI calculator).

What's your BMI? Only by knowing can we make an appropriate plan. This isn't just a number - this matters. It's not about fitting into a dress or looking good for your high school reunion - it's about staying alive.

Julie

Non Sequitur

OK, this has nothing to do with fitness.

But I'm super-excited about playing tonight at St. John the Divine. The event is a conversation with Wangari Maathai, great environmental activist & former member of Kenyan Parliament. The conversation begins at 7:00. I'll be playing viola with Nana Simopoulos on sitar and didgeridoo at 6:30. We'll be playing some really beautiful tunes by Nana.

This should be an excellent evening. Please stop by if you are in NYC tonight.

Julie