2018 in Review

Happy New Year everyone!

 I haven't updated my blog in over a year and that is good news.  It means life is humming along.

In my last post, I was recovering from what ended up being a prophylactic mastectomy. That marked surgery #9 in the past eight years and thankfully it already feels like a distant memory.

This past year, I hit some significant cancer milestones. May was my 5-year cancerversary from my recurrence! And just a few weeks ago I took my very last Anastrazole pill. Anastrozole is an Aromatase Inhibitor (AI). AIs block the production of estrogen and since my particular breast cancer was fueled by estrogen, we have been medically (and surgically) eliminating the estrogen in my body. AIs are typically prescribed for 5-10 years, however, based on some testing my oncologist felt that I had gotten maximum benefit from taking the AI for 5-years and that the benefit no longer outweighed the risks/negative side-effects (bone loss, joint pain, hot flashes, and more). I'm really excited to see what my body feels like as I clear the Anastrozole from my system.

2018 has also been a year of change. After living in Utah since 1999 we moved to Las Vegas, NV.

Home

While the move was difficult for me and definitely bittersweet, it was also perfect timing to move to a warmer climate where I could immediately ramp up my training in preparation for some early season mountain bike racing with my eye on hitting good form for the 4-Island MTB Stage Race in Croatia.

I raced True Grit 50 a few weeks before leaving for Croatia and had a fan. 

Coolest poster EVER! 

4 Islands races across a different Croatian island each respective day for four consecutive days. My recovery from surgeries was smooth and uneventful and preparation went well; we arrived in Croatia ready to perform to the best of our ability.

CROATIA!!!

This race was definitely a highlight of the year for me. Not only is Croatia a beautiful and interesting country that I had yet to explore, but the race terrain was challenging and the competition tight and fierce. Because of this, even though the race was only four days, it was one of the more physically taxing stage races I have done. Day 1, I was on fire. Our competition was close and we traded positions multiple times throughout the stage.

Finding flow Day 1 photo: Sportograf

We finished the day in 3rd overall in the Co-ed Duo category against an international field.

Day two was probably the most adverse conditions I have faced in a race for a long time. The skies opened up and it poured from start to finish making the course a combination of muddy and slick as snot and really, really cold.

A ferry would take us to a new island each morning and we would race off the ferry
photo: Sportograf

 4+ hours of this
photo: Sportograf

.....and this
photo: Sportograf

I never really recovered physically from this day and we played defense for the remainder of the race. Other teams struggled too, with one team have a major mechanical that set them back an insurmountable margin. The final day came down to a 20-second difference between 2nd and 3rd overall in our category. Shannon and I came up just short and finished 3rd co-ed duo. Despite missing 2nd by only a few seconds, after four days of racing, I knew that I had given 100%, and therefore I was 100% satisfied.

photo: Sportograf

While in Croatia we also took the opportunity to explore Dubrovnik. Dubrovnik is a Medieval-like city (known for where Game of Thrones is filmed) on the Adriatic Sea. We stayed at a little Airbnb inside the city walls and since it was shoulder season and overcast weather, we got to experience the city without the crowds. Visiting Dubrovnik was definitely an unexpected surprise.

 Riding bikes above Dubrovnik

 Me and my adventure partner

I barely felt like I had settled into Vegas when summer arrived. Vegas is scorching hot in the summer; that is my cue to retreat to the mountains! Since I work in the schools, I also happen to have summers off. In June, I returned to Park City and was back for two short weeks when I had a silly crash while on a weekend trip to Crested Butte, CO that resulted in a broken wrist (scaphoid).

This is what a broken scaphoid looks like on the outside

Most of my summer plans were derailed, but I took the opportunity to go for big hikes and attempt to trail run. While breaking my scaphoid was a bummer, I was happy to see my body heal a broken bone nicely, especially a precarious bone like the scaphoid.

Summer in the mountains is always good, even with a broken wrist.

This particular view is special because it is ours.

By the end of August, I was back to mountain biking (mostly) pain-free.  Feeling like I had missed out on my summer of racing, I put together an ambitious Fall campaign with marathon distance mountain bike races in Beatty, NV, Big Bear, CA, Pinetop, AZ and Kingman, AZ.

Grizzly 100k podium with Dizzy as my biggest fan
I finished 2nd to my teammate and National Ultra Endurance (NUE) series overall winner, Jen Toops

 I also committed to racing the local Nevada Cyclocross series. While I put in some solid training to prep for my Fall races, the first cross race was definitely a rude awakening. My body is well trained to race strong for 4-5 hours, but the power required for a 45-minute race was simply not there....and my cross skills were just plain rusty.

photo: Hugh Byrne

It was really rewarding to put in some hard work (ie intervals so hard that I collapsed off the bike) and see my body respond. Possibly the best part of racing the local cross series was that we found some Las Vegas like-minded bike crazies who also like Type2 Fun. Vegas is starting to feel more and more like home ❤️

In 2018, I also had a great interview with Dair Magazine.  Dair Magazine is UK based and is dedicated to exploring how the best coaches, athletes, and artists achieve what they do. I especially appreciated that they not only covered breast cancer survivorship and my athletic achievements, but also Metastatic Breast Cancer (MBC) which is near and dear to my heart.

Warning: here comes my soapbox:

  MBC is when breast cancer has spread to other organs of the body (brain, bones, lungs, etc). There is currently no cure for MBC. While the pink movement has done a great job of increasing awareness of early breast cancer/survivorship, little awareness and less than 2% of research funding is dedicated to MBC. 30% of early breast cancers progress to MBC and 40,000 people die of MBC each year. 

As for 2019, it is going to take me all over the country....and hopefully the world! I have lots of racing planned, but I am also challenging myself with some new endeavors. In March, I am heading to Boise, ID to be the keynote speaker at the Expedition Inspiration fundraiser for breast cancer research dinner. I am so incredibly honored to be asked to speak at this event and also nervous! I really want to blow them away with my presentation. Here's to new challenges in 2019!

I wish everyone a Happy and Healthy New Year and beyond! ....and because no blog post is complete without a photo of my Dizzy dog ❤️

A little update

A little update:

On October 3, I underwent a left mastectomy.

My surgery was scheduled in Las Vegas. My husband recently has taken a job in Las Vegas and a breast and plastic surgeon team he works with came highly recommended. So Dizzy dog and I traveled from Park City to Las Vegas and checked into an Airbnb that would serve as our home base as I recovered from surgery.

Pre-Op at UMC in Las Vegas

Although I had a right mastectomy in 2011, I wasn't totally sure what to expect this time around as my surgeons were using a different technique. I was pretty fascinated with this new technique where instead of cutting the pectoralis major muscle and placing the tissue expander underneath, my plastic surgeon placed the tissue expander over the pec muscle (pre pectoral) and supported the entire breast with alloderm.  Research shows this method to have decreased acute and chronic pain as well as improved cosmetic outcome. https://www.ncbi.nlm.nih.gov/pubmed/28574950  So far, I would say I have to agree! 

I awoke from surgery with minimal pain and only slightly nauseous. I vaguely remember Shannon and my surgeon talking about my follow-up appointment. Apparently, I was an active participant in this conversation with a drug-induced VERY LOUD voice 😂.  I felt good enough that Shannon drove me and my 2 pet drains back to the Airbnb.

Me and my pet drains

The next day I awoke with minimal pain. It truly was amazing and surprising. My rule of thumb for pain medication is if there is no pain when I'm sitting still I'm good. Tylenol and Ibuprofen were able to control my pain and I only required a narcotic for the first two nights. Based on my experience so far, a pre pectoral mastectomy is significantly less painful than a sub pectoral mastectomy. 

By day 3, I was able to go for short hikes. Nature truly does heal, I would return from my short hikes feeling invigorated and content. I also found out that the suspicious mass that started this cascade of events was completely benign. Phew! 

Hiking with drains

I found a rhythm of healing my first week post-op. I would wake up, take Dizzy for a walk on the adjacent greenway, take an afternoon nap, and when Shannon returned from work we would go for a hike with increased duration each day. 

At one week post-op one of my drains was removed and I was down to one pet drain.  Freedom! 

Note: This is a new mastectomy friendly bra made by Athleta. I have been super impressed with it. 

It is adjustable in every way imaginable, is waaaay more comfortable than the post-surgical bra, 

and it's not pink! If it had a hook for drains it would be perfect! 

At this point I felt good enough to drive myself to St. George to stay at our rental condo. While the Airbnb served its purpose well, it was so nice to stay someplace that felt like home! 

On Day 12 post-op, Shannon and I did a relatively mellow 7-mile hike in Kolob Canyon. Around every corner was a breathtaking view. I highly recommend this beautiful and accessible hike!

I also started a gentle Range of Motion program. The gentle stretching helped decrease pain, as a stiff shoulder is an uncomfortable shoulder. Note: Post mastectomy patients are at increased risk for rotator cuff injuries. It is super important to participate in consistent shoulder range of motion and stability exercises for life! 

In this photo I do not yet have full left upper extremity range, 

so I used a pillow to support my left arm as to not over stretch. 

After my second drain was removed, I returned to Park City and work. I also started riding the bike a bit starting on a recumbent, graduating to a trainer, and eventually riding the roads outside. TIP: Riding the full suspension mountain bike on the road (instead of a road bike) helps dampen out the road bumps and gets me riding outside sooner.

Weeks 3,4, and 5 I dabbled with a little off-road riding, but honestly it was like magic when I hit the 6-week mark; I could tell my body was properly healed for some legitimate off-road riding.

Park City weather has been very cooperative for mountain biking this Fall!

Just one day shy of week 7, I returned for my reconstructive surgery where the tissue expander was exchanged for a permament silicone implant.

At UMC Hospital in Las Vegas waking up from surgery. 

My surgical team has been AMAZING! 

I am now set-back to post-op Day 2. I can already tell that recovery from this much less invasive surgery is going to be quite quick, however I also know that the first two weeks are pivotal for complete healing of the incision. So, I'm back to walking.  If I'm forced to walk, there is no place I would rather be than wandering the desert of Southern Utah!

Getting some Desert and Vitamin D therapy

Seeing as tomorrow is Thanksgiving, I am so thankful for my health and this little family of mine. I will be back at it in no time and we're already making plans to make 2018 great! 

I am a Mountain Bike Lifer

I am a Mountain Bike Lifer.

Photo: Michael Darter

I started mountain biking in college.  That was the mid-90s.

At the time, mountain biking was a "newish" sport and I needed a replacement sport for Horseback Riding.  Surprisingly, mountain biking was the less expensive of the two.  Flowing through trees and being alone in the forest were just two of the things that made mountain biking appealing to me.  It was also immediately therapeutic.

Now, 20+ years later, I can honestly say that mountain biking has changed my life.  Mountain biking is special and it has always been there for me during tough times.

The past few months have been no exception.  My husband and I are in the midst of making some big life decisions, but all that seemed trivial when the results from my "routine" July MRI showed a suspicious new mass in my left breast.  This is my "other" breast.  The one that has never had cancer.  If you know radiologist lingo it was subjectively deemed a BI-RADS 4a-just suspicious enough to warrant a biopsy.

Me and my husband at the races this summer.  Photo: Michael Darter

So I went in for an Ultrasound guided biopsy.  Fortunately, or unfortunately, depending on how you look at it, the ultrasound didn't detect the mass so I was then scheduled for a MRI-guided biopsy.  Two weeks later I returned for this procedure.  The oncologist, who came in special for this my appointment, sat me down and told me he had reviewed the previous MRI and was concerned that there was a high risk of rupturing my implant during the procedure (I have a small implant to help with symmetry).  We discussed the options.  I decided to not risk the rupture on that day and made the decision to schedule a mastectomy.  It is tentatively scheduled October 2nd and will be confirmed after consultation with the breast and plastic surgeon later this month.

While this may seem like an impulsive decision, it really wasn't.  I have been thinking about getting a prophylactic mastectomy for a long time.  I just don't like down time so I was putting it off.  This mass just made it a little less prophylactic and a little more urgent.  I am at complete 100% peace with this decision.

Now, back to being a Mountain Bike Lifer.  I continued to ride and race my bike this summer, and while I was often distracted, felt fatigued due to mental stress, and even considered pulling the plug on the race season many times, I can't imagine what a basketcase I would have been without mountain biking.  Once again, mountain biking was my savior.

This past weekend I raced the Park City Point 2 Point, a 75-mile, 12,000+ feet of climbing, 99% singletrack race course that is basically in my back yard.  I have raced the pcp2p three times.  I know how hard it is both physically and mentally, and honestly, I wasn't sure until a few days before the race if I had the mental strength to finish it this year.  Finally, the Thursday before the race, I committed.  Saturday morning the alarm went off at 4:30 AM in time for me to eat breakfast and get to the race start by 7AM.  I then spent the next 8.5+ hours racing my bike as hard as I could.  While I didn't score too many PRs, I rode my personal best ON THIS DAY and that was good enough to finish 10th place Pro Women in a solid field.  For 8.5 hours my mind was completely in the moment.  I didn't think about the mass or the upcoming surgery, I focused on one pedal stroke at a time, eating, drinking, some suffering, and even occasionally taking in the views.  If nothing else, the pcp2p reminded me just how incredibly strong I am!

Park City Point to Point 2017 Photo: Angie Harker

Point to Point finish smiles Photo: Angie Harker

I now have 4 weeks of off-season before the rest of my Fall/Winter is spent recovering from surgeries.  I will happily take all positive vibes that this is a benign mass, or better yet nothing at all! As for the next 4 weeks, I plan to make the most of it!  #mountainbikelifer

Combatting the side effects of chemo

Last week I was asked by Healthline to share their new info-graphic on the side effects of chemo.  Since it also happened to be my one-year anniversary of finishing chemo (hurray for that!), I felt it was especially appropriate.

Initially, when I checked out the info-graphic I thought, "Wow, this is great information".  It really is!  Then I realized that I had experience with most of the side-effects and my thoughts changed to, "Wow, this is depressing" "chemo sucks".  Unfortunately, these side effects exist.  Fortunately, there are ways to help combat (note: help, not eliminate) them.  So while it is unfortunate that the current cancer treatment is so incredibly harsh on the body, I feel it is important to be educated so that you can work to reduce those side effects, improve healing, and maintain a high quality of life during cancer treatment and beyond.

Below you will find the very informative info-graphic with links to the Healthline website.  Since I have had more than my fair share of experience with chemo, I have added some tips and strategies I have learned to retain health and minimize side effects during treatment and beyond.

Chemotherapy affects most of the body's systems

(taken from: Healthline) 

Chemotherapy drugs are powerful enough to kill rapidly growing cancer cells, but they also can harm perfectly healthy cells, causing side effects throughout the body.

The Side Effects of Chemotherapy on the Body

Cancer cells divide more quickly than healthy cells, and chemotherapy drugs effectively target those cells. Unfortunately, fast-growing cells that are healthy can be damaged too. There are many different chemotherapy drugs with the potential for many different side effects. These effects vary from person to person and from treatment to treatment.

Factors that play a role in side effects include other ongoing treatments, previous health issues, age, and lifestyle. Some patients experience few side effects while others feel quite ill. Although most side effects clear up shortly after treatment ends, some may continue well after chemotherapy has ended, and some may never go away.

Chemotherapy drugs are most likely to affect cells in the digestive tract, hair follicles, bone marrow, mouth, and reproductive system. However, cells in any part of the body may be damaged.

Circulatory and Immune Systems

Routine blood count monitoring is a crucial part of chemotherapy. That’s because the drugs can harm cells in the bone marrow, where blood is produced. This can result in several problems. Red blood cells carry oxygen to tissues. Anemia occurs when your body doesn’t produce enough red blood cells, making you feel extremely fatigued. Other symptoms of anemia include:

• lightheadedness, pale skin, difficulty thinking, feeling cold, general weakness
• 
  

Chemo can lower your white blood cell count, which results in neutropenia. White blood cells play an important role in the immune system: they help fight infection and ward off illness. Symptoms aren’t always obvious, but a low white blood cell count raises the risk of infection and illness. People with an immune system weakened by chemotherapy must take precautions to avoid exposure to viruses, bacteria, and other germs.

Cells called platelets help the blood clot. A low platelet count, called thrombocytopenia, means you’re likely to bruise and bleed easily. Symptoms include nosebleeds, blood in vomit or stools, and heavier-than-normal menstruation.

Some chemo drugs can weaken the heart muscle, resulting in cardiomyopathy, or disturb the heart rhythm, causing arrhythmia. This can affect the heart’s ability to pump blood effectively. Some chemo drugs can increase the risk of heart attack. These problems are less likely to occur if your heart is strong and healthy at the start of chemotherapy.

Jen's tips:  I worked closely with my nutritionist to utilize nutrition and supplements to support my circulatory and immune systems as best as possible.  Additionally, recommendations were made to help protect my heart from the damaging effects of an anthracycline based chemo regimen.   While there is no way to know for certain if this nutritional advice was beneficial, I will say that I did not get a single cold throughout my cancer treatment.  Additionally, no immediate heart damage from treatment has been detected.  

Nervous and Muscular Systems

The central nervous system controls emotions, thought patterns, and coordination. Chemotherapy drugs may cause problems with memory, or make it difficult to concentrate or think clearly. This symptom sometimes is called “chemo fog,” or “chemo brain.” This mild cognitive impairment may go away following treatment, or may linger for years. Severe cases can add to anxiety and stress.

Some chemo drugs can cause pain, weakness, numbness, or tingling in the hands and feet (peripheral neuropathy). Muscles may feel tired, achy, or shaky. Reflexes and small motor skills may be slowed. It’s not unusual to experience problems with balance and coordination.

Jen's tips:  Despite perceiving myself as relatively high-functioning cognitively throughout treatment, I definitely experienced "moments" of slower cognitive and motor processing.  These "moments" seemed exacerbated by fatigue and improved with exercise, and were always worse the first few days post-infusion.  To reduce symptoms of chemo brain, I recommend adequate sleep and exercise.  To help compensate for forgetfulness, task lists became imperative and are something I still find helpful today.  

I continue to experience peripheral neuropathy primarily in my hands causing my hands to get cold easily.  I don't let this slow me down; I just purchased some Bar Mits so I can continue to ride my bike in frigid weather.  

Digestive System

Some of the most common side effects of chemotherapy involve the digestive tract. Mouth sores and dry mouth can make it difficult to chew and swallow. Sores also may form on the tongue, lips, gums, or in the throat. Mouth sores can make you more susceptible to bleeding and infection. Many patients complain of a metallic taste in the mouth, or a yellow or white coating on the tongue. Food may taste unusual or unpleasant.

These powerful drugs can harm cells along the gastrointestinal tract. Nausea is a common symptom, and may result in bouts of vomiting. However, anti-nausea medications given in conjunction with chemotherapy drugs can help alleviate this symptom.

Other digestive issues include loose stools or diarrhea. In some people, hard stools and constipation can be a problem. This may be accompanied by pressure, bloating, and gas. Take care to avoid dehydration by drinking plenty of water throughout the day.

Side effects involving the digestive system can contribute to loss of appetite and feeling full even though you haven’t eaten much. Weight loss and general weakness are common. Despite all this, it’s important to continue eating healthy foods.

Jen's tips:  I found maintaining excellent oral hygiene to be the most effective strategy for combatting mouth sores.  While undergoing chemo make sure to brush your teeth after every single meal.  Use a soft-bristeled toothbrush and run warm water over it prior to using (to further soften the bristles).   Propolis is a good, natural mouth rinse.

As for digestive health, when I finished chemotherapy in 2011 I frequently had digestive issues (diarrhea).  After completing chemo once again in 2013, my Nutritionist recommended a high quality Probiotic which I have used with excellent success.  This is one of the most expensive supplements that I take, but having a healthy digestive system is worth it!  

Hair, Skin, and Nails (Integumentary System)

Many chemotherapy drugs affect the hair follicles and can cause hair loss (alopecia) within a few weeks of the first treatment. Hair loss can occur on the head, eyebrows, eyelashes, and body. As troubling as it can be, hair loss is temporary. New hair growth usually begins several weeks after the final treatment.

Some patients experience minor skin irritations like dryness, itchiness, and rash. You may develop sensitivity to the sun, making it easier to burn. Your doctor can recommend topical ointments to soothe irritated skin.

Fingernails and toenails may turn brown or yellow, and become ridged or brittle. Nail growth may slow down, and nails may crack or break easily. In severe cases, they can actually separate from the nail bed. It’s important to take good care of your nails to avoid infection.

Jen's tips:  Many of the chemotherapy regimens for breast cancer cause hair loss.  There is simply no way around it unless you are able/willing to shell out big bucks for cold caps or something similar.  Even if you cut your hair short prior to chemo, it is traumatizing and a bit (in my opinion) disgusting when hair starts to fall out in clumps.  A lint roller works great to pick up loose hair.  Coconut oil helps soothe the scalp as it becomes tender when hair falls out.  In fact, I would lather coconut oil over my entire body, especially my hands and feet, to soothe my dry, itchy, sensitive chemo skin.  Tea tree oil is the magic potion for finger/toe nails.  I developed toe nail fungus for the first time in my life.  Tee tree oil twice daily for a couple of months did the trick.  Tea tree oil also has healing properties and I use it on cuts, abrasions, and saddle sores.

Sexual and Reproductive System

Chemotherapy drugs can have an effect on your hormones. In women, hormonal changes can bring on hot flashes, irregular periods, or sudden onset of menopause. They may become temporarily or permanently infertile. Women on chemotherapy may experience dryness of vaginal tissues that can make intercourse uncomfortable or painful. The chance of developing vaginal infections is increased. Chemotherapy drugs given during pregnancy can cause birth defects. In men, some chemo drugs can harm sperm or lower sperm count, and temporary or permanent infertility is possible.

Symptoms like fatigue, anxiety, and hormonal fluctuations may interfere with sex drive in both men and women. So can worrying about loss of hair and other changes in appearance. However, many people on chemotherapy continue to enjoy an intimate relationship and an active sex life.

Jen's tips:  Whether you are in a relationship or not, if you are even considering having children in the future, I strongly recommend a consultation with a fertility specialist prior to starting chemo.  Also, check out Fertile Hope to see if you qualify for fertility preservation financial assistance.  To combat/tolerate hot flashes I recommend first and foremost exercise and healthy nutrition.  Other strategies that have worked for me include wearing layers as my body temperature fluctuates throughout the day, carrying a water bottle with me and taking a sip when I feel a hot flash coming on, and keeping the bedroom mildly cool at night when hot flashes are at their worst.  To combat the dreaded vaginal dryness, I recommend coconut oil (yes, coconut oil has many, many uses:) and Firefly Organics lubricant.  'nuff said...  

Kidneys and Bladder (Excretory System)

The kidneys work to excrete the powerful chemotherapy drugs as they move through your body. In the process, some kidney and bladder cells can become irritated or damaged. Symptoms of kidney damage include decreased urination, swelling of the hands and feet (edema), and headache. Symptoms of bladder irritation include a feeling of burning when urinating and increased urinary frequency.

You’ll be advised to drink plenty of fluids to flush the medication from your system and to keep your system functioning properly. Note: Some medications cause urine to turn red or orange for a few days. This isn’t cause for concern.

Jen's tips:  While it is well known that maintaining hydration is vital for flushing the body of toxins and supporting kidney health during treatment, exercise can have a profound impact as well.  Clearly, I am a big advocate for exercise during treatment.  I feel strongly that moderate exercise and quality nutrition are powerful tools in tolerating chemo well.  Exercise helps improve circulation and when combined with good hydration can help flush the chemo toxins from the body more quickly.  The power of exercise (cycling specifically) was driven home to me by an Exercise Physiologist at Huntsman who told me that studies show due to the increased circulation when cycling, patients on dialysis who rode a stationary bike daily, had their dialysis time significantly reduced.  He said that cycling in particular increases circulation more than any other activity.  While I haven't personally seen this research, the Huntsman EP is a smart guy and I believe him.  Think of the power this has for flushing out chemo toxins!  

Skeletal System

Most people—and especially women—lose some bone mass as they age. Some chemotherapy drugs can cause calcium levels to drop and contribute to bone loss. This can lead to cancer-related osteoporosis, especially in post-menopausal women and those whose menopause was brought on suddenly due to chemotherapy.

According to the National Institutes of Health (NIH), women who have been treated for breast cancer are at increased risk for osteoporosis and bone fracture. This is due to the combination of the drugs and the drop in estrogen levels. Osteoporosis increases the risk of bone fractures and breaks. The most common areas of the body to suffer breaks are the spine and pelvis, hips, and wrists.

Jen's tips:  Besides having another recurrence, osteoporosis and debilitating bone fractures is one of my biggest future health concerns.  There is solid research that shows that weight bearing activities and exercise are beneficial to reduce bone loss in post-menopausal women with jumping activities being the gold-standard bone loss preventative activity.  For this reason, I jump rope, wearing a weighted vest, twice weekly.  Additionally, I do a 35 minute weight routine twice weekly and trail run once weekly with the intent of maintaining bone integrity.  Push-ups, planks, and side planks are done to help maintain shoulder and wrist stability.  I also take Calcium and Vitamin D/A/K supplements for bone health.  

Psychological and Emotional Toll

Living with cancer and dealing with chemotherapy can exact an emotional toll. You may feel fearful, stressed, or anxious about your appearance and your health. Some people may suffer from depression. Juggling work, financial, and family responsibilities while undergoing cancer treatment can become overwhelming.

Many cancer patents turn to complementary therapies like massage and meditation for relaxation and relief. If you have trouble coping, mention it to your doctor. They may be able to suggest a local cancer support group where you can speak with others who are undergoing cancer treatment. If feelings of depression persist, professional counseling may be necessary.

Jen's tips:  It is completely understandable to have feelings of sadness and depression while undergoing cancer treatment and beyond.   These side effects should be discussed with your physician and appropriate medical interventions taken.  That said, as hard as it is to get out the door and exercise when tired and achy from treatment, there is not a single time that I return from a bike ride not feeling invigorated and full of life!  

- See more at: http://www.healthline.com/health/cancer/effects-on-body#sthash.i8hkO4Dg.dpuf

Tips for staying fit and healthy while undergoing chemotherapy

Chemotherapy was not easy.  In full disclosure, I had some really bad days.  I still do.  But I had many more good days.  My primary goal while undergoing chemo was to live life to its fullest.  My goal as a competitive athlete (who hopes to compete again),  was to maintain fitness and to stay healthy.  For me, the two goals were completely intertwined.  Now that I am over two months out from my final infusion, I can say with some certainty.....GOAL(s) MET!

Although I am certainly not an expert, and realize all women experience chemotherapy differently, I feel like I now have enough perspective on my experience to share my personal strategies for meeting my goal of staying fit and healthy while undergoing chemotherapy.

1.  Keep moving.  There is quite a bit of research that supports the importance of exercise during chemotherapy, however I don't think it is emphasized enough.  In my experience, exercise is the single most important way to feel better during chemotherapy.  Somedays it may be a short walk and/or stretching.  Others it may be a 2-hour mountain bike ride.  Doing something always felt better than doing nothing.

2.  Keep a log of how you feel each day over your first infusion cycle.  For example, Day 1 post infusion I had minimal fatigue.  This was a good day to take advantage of a nice mountain bike ride.  Days 2 & 3, I felt like dirt.  I would plan to take the dog for a walk to get outside and then stretch. That's it.  Day 4 through Day 7, I started to feel better physically each day, however I still only tolerated bland food.   Each proceeding day I would feel a bit better until my next infusion.  I would plan exercise and meals accordingly.

3.  Have simple goals and try not to compare yourself to pre-chemo performance.  I put away my heart rate monitor and bike computer.  My exercise goals became very simple.  To maintain conversation pace and to keep my rides under 2 hours.  In my opinion, a heart rate monitor is useless for monitoring zones during chemotherapy anyhow.  My zones most likely changed daily.  As for keeping my rides under two hours, I noticed that if I rode for more than two hours, I would feel fatigued instead of invigorated.

4.  Try not to set yourself up to feel bad about yourself.  No matter how much fitness you are able to maintain during chemotherapy, you simply are not going to feel as strong as you did before.  I tried to ride with people who were not out to do hard training rides, but content riding at conversation pace.  Pushing myself hard to keep up was not a goal of mine during this time, while being dropped hard was bad for my fragile self-esteem.  My husband was especially generous in that he would always let me stay a wheel length ahead.  No matter how slow I was going, this little trick helped me think I was strong.

5.  Eat healthy.  During chemotherapy I started experimenting with a mostly vegan diet.  A vegan diet is not for everyone, but eating healthy meals really does help improve energy and you need energy to exercise.  Eating healthy also helps prevent weight gain.  It is well documented that most women gain weight while undergoing treatment for breast cancer.  Through exercise and a healthy diet, I was able to maintain my weight throughout chemotherapy.

6.  Eat something.  I found that the first week post-infusion I only tolerated bland food such as toast or pasta marinara.  My options were to eat a less 'healthy' bland diet this week or not eat.  For me, eating was always better.

7.  Do what you love.  Obviously I love riding my bike, but I feel most alive and free when riding awesome singletrack.  Anticipating a fun ride made it really easy for me to get out and exercise even on bad days.  In fact, riding singletrack provides such an endorphin rush to me, that I would often forget, for just a moment, that I was undergoing chemotherapy.

8.  Take care of your body.  I did acupuncture throughout treatment and had some incredible cranio-sacral sessions at the Cancer Wellness House.   I really think these sessions helped me stay strong and healthy allowing me to exercise and maintain fitness.

Well....that's it.  Those are my main tips for staying fit, healthy, and for me, happy, while undergoing chemo.

Now, if I could only figure out how to stay happy (and not cranky) while following post-surgical precautions........