GUEST BLOG: Relaxation Breathing, Stretching, and Initial Exercise Precautions

Relaxationby Carol Michaels

Exercise is good for our physical and emotional health. It is one thing that you can control and do for yourself. It is empowering. Physical activity can decrease depression and anxiety, reduce stress, increase confidence, and build positive health habits. Exercise can improve endurance, increase energy level, and decrease the fatigue that may be caused by treatments.

Relaxation Breathing and Stretching
There is an emotional toll that cancer survivors face in addition to the physical one. A cancer diagnosis can cause depression, anger, anxiety, fear and stress. Proper breathing techniques and stretching can improve the psychological recovery.

Research has shown that breathing can help reduce stress and anxiety. When feeling stressed, we usually take shallow breaths. During these exercises we will use our full lung capacity and breathe slowly and deeply. You should be aware of your breathing as it has a calming effect. Inhale for 5 seconds and fill the torso up with air, then exhale from the lower abdomen for 5 seconds, pressing the navel in towards the spine. Imagine all of your tension and stress leaving your body with each exhalation.

You should begin relaxation breathing immediately after surgery, as it allows you to focus all of your energy on healing. The stretching program will restore mobility in the chest and back that allows for freer movement of the lungs and diaphragm. We will discuss stretching in a future article.

Cancer surgery and treatments affect many areas of the body. I hear numerous complaints of stiffness, pulling, tightness, and a lack of flexibility. Often this occurs when the muscles and skin are shortened because of the surgery, which can also leave scar tissue. Surgery can irritate the nerves. As a result, you may feel burning, tingling, or numbness.

When can you start an exercise program after having cancer surgery and treatments? You should start stretching exercises as soon as you get clearance from your doctor. It is important to talk to your doctor before starting to exercise. This way you can determine what program is right for you.

Initial Exercise Precautions:

  1. Your immune system may be compromised, which places you at risk for infection. Gyms carry a high risk for infection. Exercise at home while your immune system is weak.
  2. If you have poor balance, you may want to start with exercises that are safer for those who have balance problems. Poor balance may be due to the chemotherapy, weak muscles, neurological issues, or normal aging. A common side effect of chemotherapy is peripheral neuropathy, which changes the sensation in the legs or arms. It can last a short time or be long-lasting. This can affect the way you walk, your balance, and your general movement. If you have peripheral neuropathy, you should select activities that decrease your risk of falling. For example, we recommend avoiding uneven surfaces and exercising with a stationary bike instead of a treadmill without handles. Strengthening your core will help your balance. It is also a good idea to keep all the muscles strong to compensate for the ones that are affected by the neuropathy.
  3. Be smart and safe by doing the exercises that are right for you at this particular time. You are exercising to get healthy, not to get hurt. This is an important point to keep in mind, particularly for those who were physically active before cancer. You will not be able to immediately resume the same level of pre-cancer activity.
  4. Exercise in a temperature controlled environment. Cold temperature can crack your skin, while extreme heat can cause swelling or light-headedness.
  5. At the start of your exercise program, you should warm up with deep breathing techniques and shoulder rolls. We recommend that you warm up before you stretch by walking, marching in place or using a stationary bike. You can also exercise after a warm shower, which may relax the muscles.
  6. Never hold your breath during an activity. People often hold their breath during exercise, so remember to breathe deeply.
  7. Drink plenty of water, especially when sweating.
  8. If your blood count or the mineral levels (potassium and sodium) are low, check with your health professional before resuming exercise.
  9. Some medications affect the heart rate, so your pulse rate is not a good indicator of the level of your exercise exertion.
  10. Learn to move slowly and smoothly without jerky movements. Do not continue an activity if it causes pain or unusual fatigue. You should feel a gentle stretch, not pain.
  11. Know your limits. You should be able to differentiate between discomfort and unusual pain. Stop if you feel pain.  Listen to your body and use common sense. If something does not feel right, do not do it. You should consult with your doctor if you are experiencing pain, swelling, or unusual fatigue.
  12. Wear comfortable and loose clothing and appropriate footwear. For those with peripheral neuropathy affecting the feet, supportive footwear is particularly important.

Exercise Progression
Many variables determine the exercises that are effective and safe for your particular situation. Every day brings new challenges and new accomplishments for the cancer patient. It is important to be able to modify your exercises to fit your needs at a given time.

Pain and fatigue levels can change from day to day, and even from hour to hour. You may wake up feeling fine, but may have increased fatigue as the day progresses. Track your energy levels throughout the day to determine the best time to schedule your exercise sessions. For example, if you have more energy in the afternoons, you should exercise in the afternoons.

Exercise when your energy levels are high. Common sense and listening to your body are of utmost importance. You should not feel like you have to follow a set protocol or a strict schedule. Your routine must be customized due to the numerous physical and psychological side effects you may be experiencing.

Both healing times and pain tolerance can differ greatly from one person to the next. Speed of recovery depends on your pre-surgery fitness level and type of surgery and treatments. The progression and timing of a cancer exercise program can only be determined after a thorough discussion between the patient and her or his healthcare professional.


Carol Michaels FitnessCarol Michaels is a cancer exercise specialist and creator of the Recovery Fitness cancer exercise program. Recovery Fitness is taking place at Morristown Medical Center and several other facilities in New Jersey. Michaels also wrote “Exercise for Cancer Survivors,” a resource for cancer patients going through surgery and treatment.

Caregiver Burnout: The Unspoken Suffering of the Caregiver

Caregiverby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

Speak to any caregiver and they will share with you the rewards of caring for a loved one when tragedy strikes. In the beginning, the tasks are met and the list items ticked off one by one. It feels good to be unselfish; the endorphins are sending us messages that we have become the noble self that we had hoped one day to become.

Months go by and the caregiver looks up and thinks ‘Oh my God, will this ever end? Where am I in this process and how did I lose my way?’ The caregiver is not a machine. No human being is programmed to be on high alert 24/7, ready to handle any emergent situation that arises. The caregiver is the unselfish, ever giving angel of mercy residing in the home of a cancer patient. Friends and family can see the signs of burn out, but the caregiver wears this as a badge of pride often until “something gives.” It may manifest as an emotional outburst or extreme exhaustion may take over, and all of a sudden, the world of the caregiver has crumbled.

If you are caregiving for a spouse, stop what you are doing now and sit down with your loved one and tell each other why you came together and why you have stayed together. Yes, caregiving may be somewhere on the list, but my hunch is that it is not one of the top reasons why you are together. Despite the diagnosis of cancer, a patient and a caregiver can still find joy in their relationship and, yes, even a laugh or two. Come back into the 20th century, spend a dollar and get Amazon Prime or Netflix, and look for those comedies that will make you both laugh out loud. Laughter is the best medicine, both for the caregiver and for the patient. Walking into the home of a cancer patient should not feel like walking into a church or a museum, but a place where a living, breathing human resides.

Caregivers, take 30 minutes each day for you. Do this early in the journey. In academics, we call it protected time. Whatever activity you choose should be strictly for your benefit. If you can take a bit more, join friends for lunch, or better yet, go to an exercise class. Invite them for dinner so you both can enjoy socialization and stimulating conversation that does not revolve around “when the next treatment is scheduled” or “have you taken your medicine yet?”

Let’s get the conversation going. Please let us know what works or has worked for you during this stressful time. Caring for the caregiver should be a priority, as few realize that the caregiver is also suffering during this cancer journey.

Importance of Dental Hygiene for Mesothelioma Patients

mouth_smallCancer therapies often result in xerostomia (dry mouth), a condition that can lead to increased risk of infection and cavities. Bacteria in the mouth are kept in check by saliva, which is a crucial fist line of defense in maintaining good oral health. When there isn’t enough saliva produced, or the amount available isn’t enough to clear infection-causing bacteria, it is possible to develop sores and excoriated tissue. Dry mouth is also a causative factor of malodorous breath and cavities, as food particles are not cleared away as quickly as they would be in a well-hydrated state.

Symptoms of dry mouth include stringy saliva, cracked or dry lips, difficulty speaking, and a burning sensation. When the mouth becomes too dry, chewing and swallowing are affected and may increase the risk of aspiration pneumonia, a life-threatening condition for at-risk cancer patients.

In mesothelioma patients, xerostomia is most often caused by chemotherapy, but lack of hydration and sometimes radiation can also be the culprits.

Xerostomia can be treated with medications to stimulate the production of saliva or with over-the-counter chewing gum and mouthwashes, depending on the severity.

Scheduling a dentist appointment before initiation of chemotherapy is a good practice to follow in order to identify and correct any dental conditions. Once chemotherapy has begun, patients should  brush 3 to 4 times daily, as vomiting and acid reflux are known to erode dental enamel. During this period, fluid intake should also be increased and gentle flossing should be continued. If platelets become low, patients should discontinue flossing until advised to resume.

It is important for mesothelioma patients to schedule regular dental check-ups. Because some dental interventions should not be performed when a patient is at a high risk for infection or bleeding, patients should inform their dentists if they are receiving chemotherapy treatments.

FROM THE HEADLINES: The Mesothelioma Applied Research Foundation Appears before the United States Senate Committee on Appropriations

Last week, on June 6, 2012, Mary Hesdorffer, MS, APRN, nurse practitioner and medical liaison for the Mesothelioma Applied Research Foundation, appeared before the United States Senate Committee on Appropriations – Subcommittee on Defense, at their Fiscal Year 2013 Appropriations Outside Witness Testimony Hearing. Speaking with the voice of the Meso Foundation and its community, Mary made an appeal to the lawmakers for their attention concerning mesothelioma and its impact on those who served to defend the United States.

The Meso Foundation played a critical role in making peritoneal mesothelioma and pleural mesothelioma eligible topics within the Congressionally Directed Medical Research Program. The first ever DoD award for mesothelioma occurred in 2008 when one investigator obtained over $1.3 million for research. A total of $7.7 million has been awarded to mesothelioma research through the Peer Reviewed Medical Research Program and the Peer Reviewed Cancer Research Program, both divisions of the Congressionally Directed Medical Research Program, which is administered by the Department of Defense since Fiscal Year 2008. Continue reading “FROM THE HEADLINES: The Mesothelioma Applied Research Foundation Appears before the United States Senate Committee on Appropriations” »

GUEST POST: An ASCO Update from Dr. Lee M. Krug, MD

The Meso Foundation is happy to present this special guest blogpost from Lee M. Krug, MD, Associate Attending Physician in the Division of Thoracic Oncology, Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York, New York and Director of the Mesothelioma Program at Memorial Sloan-Kettering Cancer Center. Dr. Krug has investigated multimodality approaches for patients with early stage malignant pleural mesothelioma, has led a multicenter U.S. trial of induction chemotherapy before extrapleural pneumonectomy, and has a current study testing the feasibility of chemotherapy followed by pleural radiation. Dr. Krug also has a strong interest in novel therapeutics for patients with more advanced disease, and is the principal investigator of an international, phase III trial of a histone deacetylase inhibitor, vorinostat. Dr. Krug led the committee for the National Comprehensive Cancer Network (NCCN) that established treatment guidelines for mesothelioma, and is currently the chairman of the Scientific Advisory Board and serves on the Board of Directors at the Meso Foundation.

The Annual Meeting of the American Society for Clinical Oncology (ASCO) was held in Chicago, IL from June 1-5, 2012. This is the largest meeting in oncology each year with over 25,000 attendees from all over the world. Several abstracts of interest to mesothelioma were presented, so I thought I would summarize the results of a few of the most interesting:

Randomized Phase II Trial of Pemetrexed/Cisplatin with or without CBP501 in Patients with Advanced Malignant Pleural Mesothelioma: CBP501 is a novel compound that enhances the ability of cisplatin to damage cancer cells. In this international trial, patients received treatment with standard chemotherapy (pemetrexed and cisplatin), or they received it in combination with CBP501. 63 patients participated in total; 40 were in the group with CBP501. The only additional side effect of CBP501 seemed to be a rash that occurred during the infusion. Forty percent of the patients who received chemotherapy plus CBP501 had tumor shrinkage as compared to 17% of the patients who received chemotherapy alone. The average time before the cancer grew back was 5.9 months in the CBP501 arm, and 4.7 months in the other arm. Although the patients who received chemotherapy alone fared less well than expected, the results seemed encouraging. Another similar trial with CBP501 has also been conducted in lung cancer and until those results become available later this year, plans for future trials are unclear. Continue reading “GUEST POST: An ASCO Update from Dr. Lee M. Krug, MD” »