She was living the dream in a beautiful house, happily married 22 years with three highly motivated children, and managing a fulfilling and successful nonprofit venture. Lesley Glenn also lived a healthy lifestyle: She ate right, and she exercised, doing cardio and resistance training and High Intensity Interval Training (HIIT).
Then, in October 2012, Glenn, 47, of Chino Hills, California, found a lump in her right breast. It was ultimately diagnosed as Stage IV metastatic breast cancer after she underwent a biopsy on her shoulder that also showed cancer.
"I asked myself, 'How do you want to live the rest of your life?' And I decided to make some changes," Glenn told HealthCentral in a telephone interview.
She vividly recalls the rigors of three devastating chemotherapy rounds that pummeled her immune system. Glenn contracted sepsis twice through the port in her chest, an IV (intravenous) catheter under the skin to deliver chemo drugs and antibiotics. She was hospitalized, and once, her blood pressure plummeted to dangerous levels. She underwent radiation for her bone metastases in July 2013, which resulted in some scarring on her shoulder.
"I realized that the side effects of the chemotherapy I was being administered were having a detrimental and altering effect on my quality of life," Glenn says. "I took more control of my treatment plan, asked for changes to be made to reduce my side effects, and became my own best advocate.”
Once out of the hospital, Glenn says she "started moving on my behalf, even in my weakest moments." From then to now, she's had no evidence of active disease since 2014. She's proud to be what she calls a "Stage IV MBC Thriver/Advocate."
Training for her life
Stronger and with imaging showing no active signs of cancer, Glenn took on a tall challenge. From January to September 2015, she trained to climb Mt. Whitney, the highest point in the contiguous United States at more than 14,000 feet.
After eight months of preparation, Glenn reached the summit on Sept. 21, 2015, in triumphant honor of her 50th birthday.
"That training became the positive trajectory for the rest of my life," she says.
Her self-care regimen also includes meditation, a healthy diet and saying "no" more than "yes." She relies on her on intuition and avoids drama and negativity. Now, Glenn goes to the gym regularly, does trail running, and credits physical activity for her positive and generally stress-free mindset.
“I would hope that by keeping my mind and body focused on my overall wellness that if my next scan showed progression, I would be more emotionally able to face that,” she says.
Glenn also resists telling other patients what to do.
"Not everybody can have the Mt. Whitney experience, but maybe reaching the top of the hill in their neighborhood makes you proud that you've really accomplished something — and you have!"
The benefits of exercise with metastatic breast cancer
"There are good observational studies that show exercise decreases the risk of developing cancer," says medical oncologist and hematologist Pallav Mehta, M.D., director of integrative oncology and director of practice development at the MD Anderson Cancer Center at Cooper in Camden, N.J. A former personal trainer himself, Dr. Mehta is also a member of the board at Living Beyond Breast Cancer.
"Cardio, resistance training and flexibility — they're all important to patients for different reasons, just as they are to people without cancer," he told HealthCentral in a telephone interview.
Dr. Mehta is also encouraged that the latest proven treatments for metastatic breast cancer focus more on targeted therapeutic strategies rather than chemotherapy alone.
"Chemotherapy can cause restricted immune function, electrolyte abnormality, diarrhea, vomiting, dehydration, and reduced levels of sodium,” he says. “Low levels of potassium can occur, which causes an electrolyte imbalance, which in turn can cause arrhythmia. In some people but not all, exercise can worsen those things."
With metastatic disease, and if a patient is receiving chemotherapy, several factors must be considered before undertaking exercise:
Blood chemistry: Updated blood work is a priority, he says. "If white blood cells are too low on a certain day, maybe you don't work out as hard — do it at home instead of a public gym."
Bone abnormalities: Reduced bone density is a common side effect of metastatic disease, says Dr. Mehta. Bones with cancer are weaker and more prone to fractures. "Even doing something as simple as lifting a child or another object, it's important to use correct lifting form to avoid spinal compression or a fracture," he says. The American Academy of Family Physicians recommends using arms, legs, and core muscles to lift — not the back. Bend knees, use proper posture, and go slowly and smoothly. Runners with spinal bone loss should proceed with caution.
Port: Exercise that's too vigorous can disturb its position. "That includes push-ups, pull-ups, and flies," he says. "Those movements that extend the arm in certain positions may be risky."
Neurologic effects of chemotherapy and radiation: Effects on the brain and spinal cord, as well as peripheral nerves, can cause neuropathy, balance issues and loss of sensation, which also affect depth perception and even judgment, says Dr. Mehta. These factors increase your risk of falling.
The psychology of exercise
For Dr. Mehta's patients on active cancer-fighting therapy, there is evidence that exercise improves fatigue and improves feelings of well-being, whether caused by the cancer or the chemotherapy. He recommends moderate intensity — 20 minutes a day at least 5 days a week.
The Centers for Disease Control and Prevention defines moderate intensity as walking briskly, water aerobics, bicycling slower than 10 mph, doubles tennis, ballroom dancing, and gardening.
"For the more serious athlete, a heart rate monitor is also a great way to gauge intensity," says Dr. Mehta. You can find these monitors at a variety of stores or online from approximately $15 to upwards of $200.
"Many times patients ask me, 'How did this happen? I do everything right for my body,'" he says. "I say that maybe if you weren't doing those things, your situation could be much worse. Patients with metastatic breast cancer who exercise tend to feel better and do better, and to undergo treatment with fewer side effects."
Dr. Mehta works closely with his patients to incorporate exercise. He tells them, "I want to get you back to your life as much as we can, so you continue to do the things, like exercise, that you used to do. Yes, tests and treatment can interfere, but you can still get on with your life."
As for Glenn? She has made a pact.
"I've learned how to be grateful and how to treat the body as a friend, not my enemy," she says. "I say, 'I need to take care of you. We're in this together.'"
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