An Inside Job: Yoga and Cancer

“What Do People Plan?” Daisy, in F. Scott Fitzgerald’s, The Great Gatsby

Human beings like to plan for our lives. Even without a defined set of expectations, we quickly learn that we will get stuck without some advanced preparation.

Wash your hands, pack a raincoat.

As students of Iyengar yoga, our life plan includes behavior that promotes good health and well-being. Yoga helps us cultivate a healthy body and mind. We eat well, we use natural body and cleaning products, and have myriad healthy habits. The framework of Patanjali’s Yoga Sutra provides a lovely framework for discipline and good living. As a rule, we are a group who feel empowered by taking control of our health. Even before I took my first Iyengar yoga class over 29 years ago, I followed a path of healthy living.

I now recognize that these practices gave me the illusion of control, and that need for control was an illusion. Discipline had long been a helpful coping mechanism for me, and I lived by the principals of abhyasa—practice and persistent effort—even before I understood what it was. Events in my recent past offered me a front row seat before the principles of detachment and letting go, which now gives me a much clearer perspective of vairagya—letting go of fear and accepting what is .

I live fully suspended between the twin pillars of yoga…vairagya and abhyasa.

Abyhasa—practice—matters to me, but I now have a much keener view of vairagya and being fully present with the way things are.

“Illness is the night-side of life, a more onerous citizenship.

Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

-Susan Sontag

Two years ago, I finished 6 months of high dose chemotherapy for Stage 3-B Hodgkin Lymphoma, an aggressive blood cancer which just a generation ago was a certain death sentence.

I am still in remission, thanks to the miracle of modern medicine. Treatment has included well over 100 blood draws which test 45 items, ranging from blood cell counts to liver and kidney function, and I have endured well over a dozen CT and PET scans, two surgeries, three hospital stays, and a week in the ICU from a bout with deadly sepsis . I received a very strong but very effective combination chemotherapy called ABVD: Adriamyacin/doxorubicin, bleomycin, viniblastine and dacarbazine. Each of these drugs has horrible side-effects and doxorubicin and viniblastine are known to cause latent heart and lung damage. I am statistically at risk for secondary cancers and a list of latent effects from the treatment. On the positive side, however, these chemicals have so far eradicated my Hodgkin lymphoma. Fast growing or aggressive cancers respond very well to chemotherapy because the rapid rate of cell turnover enables doctors to better target these cancer cells.

My maintenance, referred to as a survivorship plan, includes regular visits with my oncologist/hematologist for blood tests and for lump and bump checks. Since lymphomas are typically not diagnosed through blood markers, I still have to undergo routine PET and CT/PET scans. I am exposed to high levels of radiation from these scans, but I accept them as being medically necessary at his point.

You are never really finished with cancer. Post-treatment, you’re in the middle of your story. If you survive, you remain in the middle of your story, and it becomes a very joyful place to be. The specter of recurrence looms over me, but it helps me to shift into the present moment like never before. Life is richer, fewer things are taken for granted, and little things that used to bother me no longer tend to bother me as much. Cancer treatment aged me physically. Cancer diagnosis also aged me mentally, and I believe I am, in many ways, wise beyond my 56 years.

“There’s nothing more debauched than thinking. This sort of wantonness runs wild like a wind-borne weed on a plot laid out for daisies.”

Wislawa Szymborska

I spent months with blood counts so low (called neutropenia) that I virtually had to stay away from everyone and everywhere except the hospital and the offices of the Colorado Blood Cancer Institute. The beauty of being confined and isolated was that I had time to read constantly.

Since I had virtually no control over my life, I was determined to take control of what I could learn. When not at medical appointments, I read voraciously about cancer and science.

I learned that the more you know, the more you don’t know.

“What if this mixture do not work at all? What if it be a poison?”

Juliet, in Shakespeare’s, Romeo and Juliet

Cancer is an exceedingly complex disease that humans have lived with and died from for over five thousand years. Cancer was once a clandestine and shameful illness. Cancer treatment is a very new science, and chemotherapy has only been in use since the 1950’s. Clinical drug trials are still an enormous part of cancer treatment, because the medical community is still in the research stages of treatment. Immunotherapy is the latest breakthrough, but it remains in its infancy in terms of truly curing cancer.

Broadly speaking, 90% of all cancers are carcinomas or tumor cancers, 9% are blood cancers and 1% are sarcomas. There are countless sub-types within each of these categories. For example, there are five sub-types of Hodgkin lymphoma, and roughly 100 sub-types of non-Hodgkin lymphoma. Some non-Hodgkin lymphomas are indolent, slow-growing and are called marginal zone cancers that do not require treatment. Others, such a mantle cell lymphoma are aggressive and deadly. In the book, When Breath Becomes Air, Paul Kalanithi said, “There is cancer, and then there is cancer. “ Every single cancer is unique and every individual manifesting the disease is unique.

Though there have been phenomenal breakthroughs, the average life expectancy of all patients, when averaged together, from the time of diagnosis to the time of death, is just 6 years. There is still much to be done in what President Richard Nixon once described as the United States’ “War on Cancer.”

“Understanding someone’s suffering is the best gift you can give another person.

Understanding is love’s other name.”

Thich Nhat Hahn

Since cancer patients are now living years instead of just months with certain types of cancer, it is increasingly likely that we will meet cancer survivors in our yoga classes. I feel strongly that yoga teachers should learn more about cancer so that we can be better prepared to help cancer patients and survivors.

If a student with cancer or a cancer survivor comes to class, do not make assumptions.

Find out as much as you can, depending on the comfort level of the person sharing. I am astounded to learn how differentiated people’s individual responses are to their cancer. I have met people who want to talk about it, who want to learn about, and then I have met people who seem to know nothing about their disease, and who prefer to remain ignorant. For some, it is too frightening to have a closer look. We must respect their way of being. Teachers, tap into you everything you ever learned in teacher training about the skill of observation.

I wish that I could say that there are general guidelines as to how to treat an individual who comes to class as either a patient or as a survivor. I believe that our first role is to take care of this person emotionally. It is essential to observe how they might be feeling. How is their anxiety level? Honor any trauma they may still be experiencing. If you can help them to relax, you are giving them a tremendous gift. This is a good starting point for how to proceed.

Advice as to what cancer patients/survivors should do to promote better health varies widely.

There is no hard and fast rule as to how active or how inactive a person should be, especially when they first complete treatment. Encourage the student to pay attention to his or her body. Very generally speaking, the Western model is that patients should try to be active, as long as they feel up to it, or do not have medical complications.

My oncologists all encouraged me to be active when I felt up to it. The stem cell/ bone marrow transplant floor at the hospital where I was treated in Denver, Colorado, has stationary bicycles that the doctors and nurses encourage patients to use. When I was at this inpatient facility, we were encouraged to get out of bed and walk the halls, even though we looked like bald clowns, connected to IV poles, donning yellow paper gowns.

To be active or not to be active. There are no hard and fast rules. There is so much we still do not understand. Again, every cancer is different, and every individual is different.

“Sweet are the Uses of Adversity” William Shakespeare

Post Traumatic Growth is a phrase I now use to describe my situation over the past two years. Initially, I experienced tremendous fear and had to learn to accept how helpless I was. I was stripped of the identity I once held, and showing up for treatment became a full time job.

I felt a very strong desire to live, though I did not ascribe to the concept of fighting cancer. I felt great relief that there was medicine to do the fighting for me, and it was up to me to befriend my body. I made direct eye contact with death for several days in the ICU with an uncontrolled infection. I was calm as I stared down death. Abhinivesa, clinging to life, is complex, as the will to live is a powerful thing. I believe this will of ours comes and goes. We are alone when we walk the razor thin line between life and death, and cannot predict what we will experience when facing our own mortality. May our mini-death experiences we have each time we practice savasana help us find peace.

Technicolor Vision

Technicolor was a brand new high resolution color technology first introduced by MGM when they produced The Wizard of Oz, 80 years ago, in 1939. Heightened, brightened color came to life on the big screen. When I completed chemotherapy and began to feel better, I felt that I saw the world through Technicolor vision. I hoped that I would never forget how light and bright things appeared. I try to remind myself every day to notice how precious life is, and I tap into that initial hypersensitivity and appreciation of life’s beauty.

Each time you stay present with fear and uncertainty, you are letting go of a habitual way of finding security and comfort or hiding from feelings. This is one of the positive side effects of a cancer diagnosis.

First-hand suffering and illness can turn into something incredibly beautiful.

No one can truly comprehend what it is like to have cancer unless they have been diagnosed. Cancer survivors have a front row seat to our own mortality. This new awareness changes one in many positive ways.

When I feel gripped by the fear of recurrence or begrudge the possible side effects from the harsh chemotherapy I received, I try to shake the fears off. I still try to take charge of my health, though I am somewhat cynical about the anti-cancer diet and the naiveté in thinking that one can actually prevent cancer, by eating right or following certain guidelines. Acceptance and practice are two ends of the spectrum. Most survivors I have met describe the nagging element of fear as a new state of normal. We are changed. Many I have met have also shared that they have learned to focus much more on the present and also have learned to not let small things get in the way of living life to the fullest. I remember being stuck in traffic one day just a few months after my treatment and I laughed at the realization that I was fortunate to be stuck in traffic because it meant that I was not dead!

Early this winter, my sister called me in a state of upset because her furnace had failed. No big deal! Make a plan. Put on a coat, grab a blanket. This does not mean that I see the world with rose-colored spectacles, and I try not to judge when people get upset over very small matters. I still have bad days, just like everyone. I live with the fear of recurrence on a regular basis. When I go to the doctor, I get white coat syndrome and my typically very low blood pressure is always high.

Cancer is not a gift, but has presented me with a treasure trove of growth. It has given me a new perspective, and has enhanced life’s richness. When you see clouds from above the earth as in riding in an airplane or hiking at high altitude, the clouds have an intensely different beauty because your perspective has changed.