Cancer and me: a bike and the psychiatric ward.

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Almost a year ago, after being diagnosed with my third cancer in as many years, I was admitted to hospital to start chemotherapy.  This new cancer, Diffuse Large B Cell Lymphoma (DLBCL), was aggressive and required an aggressive treatment protocol that consisted of being hooked up to a chemotherapy infusion pump 24 hours a day for nearly 7 days straight.

An IV line was put into my arm (PICC line) near the crook of my elbow and it ran through the vein up to a larger vein at the top of my chest.  Besides being painful, this concerned me since I wanted to maintain the exercise routine that I had established in anticipation of needing chemotherapy.  But this turned out to not be my real problem, finding a stationary bike was.

I asked my nurse if there was a stationary bike that I could use.  I was surprised to hear that they had none on the oncology ward, and I was equally surprised to hear that in her 5 years of working there that no one had ever asked to exercise on a stationary bike.  This was an MD Anderson affiliated hospital, and MD Anderson is the #1 ranked cancer hospital in the US, I was disappointed to realize how little exercise was being used as a part of cancer treatments.

There were some bikes in the cardiology unit (exercise is a part of rehab after a heart attack) but I wasn’t able to use them because cardiology was in another building and that would require me to go outside to get there – not allowed.  A patient coordinator then set about trying to locate a bike for me and her initial search found one in the basement of the psychiatric ward.

In order to get to the bike I had to navigate some stairwells, so they reluctantly disconnected me from the infusion pump and gave me one hour to complete my exercise and to shower afterwards.  I also had to be escorted and accompanied by a nurse (not the shower though), so off we went.

Arriving at the psychiatric ward was a bit surreal.  In the small lobby there were two locked doors, one of them had an unsettling notice on it ‘extreme escape risk’.  I wondered about the patients behind the doors, each going through something different from me but also sharing something similar – the need to get healthy again.  This was a sobering reminder that there were other debilitating things besides cancer, and that my health issues, although somewhat complicated and rare, in the grand scheme of things, were nothing special.  I felt fortunate, I was beginning my recovery with a clear action plan, literally too, and with an understanding of what I needed to do and why.

After buzzing for assistance we were given the okay to go to the basement where the bike was.  Down more stairs we came to an old, small, gym.  It was odd, with ceramic tile walls and bars on the windows, and most of the equipment had been abused and was in need of repair.  The only decently functioning piece of equipment was an air-dyne bike, this is the type with big fan blades on the front wheel, which makes cycling at higher RPMs difficult, if not impossible.

Another problem was that the bike’s handlebars were connected to the pedals, this made the handlebars move backwards and forwards with each pedal revolution.  I was not going to be able to use the handlebars that way because I was still sore from the PICC line in my right arm.  Plus, my left arm was also sore from the recent biopsy surgery done in order to confirm my cancer diagnosis.  A final problem was that there were no toe clips on the bike.  For support, I held on with my left hand to a broken display console that was mounted between the handlebars.  With no toe clips and a fan for a front wheel, this was going to be one interesting, if not difficult, ride.

For a moment I thought about the situation, me: chock full of tumors, in a psychiatric ward basement, chemotherapy drugs still coursing through my veins, and wanting to ride a dysfunctional exercise bike.  I chuckled nervously to myself, maybe I belong here.  Then I started pedaling.

As a runner, I broken 4 minutes for the mile, ran under 2 hours and 10 minutes for the marathon, and won numerous races around the world, but I never accomplished anything more uplifting than turning the pedals on that derelict bike.  I rode that thing for 30 minutes while trying to control my emotions so that I could finish the workout and still have time to shower before being hooked up again to the infusion pump.  The nurse was nearby texting on his cell phone, unaware of my riding predicament or of my emotions.

Prior to being admitted for chemotherapy I had been researching exercise and cancer treatments, and I had come across only one study, done on a small group of breast cancer patients, where someone had exercised during chemotherapy infusion.  I had advocated that there be more studies on whether this could improve a patient’s response to chemotherapy – could exercise during infusion enhance chemotherapy and increase survival rates?  I already knew that exercise was good for my quality of life, but now it was my turn as guinea pig.  This added a different perspective to a study of this type, and it increased my respect and appreciation for patients who volunteer for research studies or clinical trials, they are heroes to me.

In the basement of that psychiatric ward, while riding a rickety old exercise bike, and with chemo drugs doing their thing inside me, I was alone with the enormity of that moment … and I was elated.  Somehow this all seemed to fit for me – a bike, science, and faith, versus cancer, and I liked my chances.

 

NOTE:  The hospital’s patient coordinator was able to locate a better bike in a storage room and they kindly brought it to my room for the remainder of my first chemo cycle.  I was then able to exercise without being disconnected from the chemotherapy infusion pump.  They also had the bike waiting for me when I started my 2nd chemo cycle (no pun intended) two weeks later.

References/links:

A summary of my exercise intentions regarding cancer treatments (with scientific references at the end)

http://workoutcancer.org/Treatment___exercise.html

US News and World Report, Hospital, specialty – cancer

http://health.usnews.com/best-hospitals/area/tx/university-of-texas-md-anderson-cancer-center-6741945/cancer

A pilot study of aerobic exercise performed in breast cancer patients during chemotherapy infusion.

http://meeting.ascopubs.org/cgi/content/abstract/28/15_suppl/e19527

Cycling through cancer

http://www.indystar.com/article/20130331/LIFE02/303310045/

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6 thoughts on “Cancer and me: a bike and the psychiatric ward.

  1. Ken – your writing is emotionally touching and inspirational. I pray for you and your family all the time. I admire your strength, stamina and determination. Thanks for providing perspective as the the rest of the world and I get caught up in the little things that are completely insignificant…

    • Sometimes the little things are very interesting, and I too get caught up in some of the insignificant things. I’ve had a number of people suggest I run a marathon again or do something else monumental, but I’m please with just a sound fitness routine, besides, I can never top that bike ride in the basement.

      Thanks for your support and kind words!

  2. Ken, I have long admired your strength and tenacity in your cancer battle(s). I knew you were a survivor, but I didn’t realize how determined you were to stick to your treatment plan until I read this lovely essay. Continued strength to you and your family!

    • Thanks Jenny! I simply view exercise as an integral part of cancer treatments, and not as something that’s optional. The window of opportunity with some treatments can be small, tumors can become resistant to drugs as well as to radiation therapy. My intent was to maximize the response to those first few treatments before any resistance occurred, and the emerging role that exercise might have in that regard seemed like an opportunity I shouldn’t miss.

      But we need more research in this area, my story is only anecdotal evidence, that is why I started WorkOut Cancer research fund.

      Continual thriving survivorship to you!

  3. Dear Ken,

    I also read that abstract and thought it was of interest to research what actually happens physiologically to the chemotherapy drugs if you actually exercise when being infused. I am an immunologist / biochemist who has been working in the area of cancer and exercise for 14 years now… and have trained over 400 people with cancer and over 200 fitness instructors to the UK level 4 qualification to work with clinical patients in the community. The ACSM guidelines say no exercise for 24 hours prior to blood draw but I don’t see any evidence to support this. I would be interested in doing a study with some patients to see what happens to lymphocytes, NK cells and inflammatory markers like CRP, Il-6 during exercise with getting chemo. The only advice I give is to watch the Hickman PICC line doesn’t come out. In my study published in the british medical journal of 200 women in the middle of treatment for breast cancer – the 100 women who exercised (group class) spent less nights in hospital and visited their GP less than those who did no exercise during treatment – suggesting a positive outcome during treatment,

    • Anna,

      Yes, the ACSM Guidelines are very general, basically the same as the 2008 Physical Activity Guidelines for Americans (http://www.health.gov/paguidelines/guidelines/default.aspx ). Regarding exercise, there is so much that is not known in the clinical setting of oncology, however, if extrapolating the body of knowledge in exercise physiology to oncology, there should be benefit, even at the tumor tissue level, which could improve existing treatments. I hypothesize that hypoxia is hypoxia, wherever it is, and that Circulating Angiogenic Factors via chemokinesis reach the hypoxic tumor microenvironment and modify it.

      Since many drugs are metabolized in the liver, have you investigated liver blood flow and pharmacokinetics during exercise? In my limited research I’ve found contrasting results (1, 2, 3). As you say, knowing what exercise may do to the drugs would be important indeed. I list that as one of the questions I had regarding my treatment experience: http://workoutcancer.org/Treatment___exercise.html#.UwIXtmRDuuo

      I did a small literature search & study on IL-6 last fall. It appears that production (or less so) of IL-6, TNF-a, & IL-1b are different between exercise, a chemo drug (6), or a pathogen (5). Bente K. Pedersen’s group has done a lot of good research on IL-6 (4), and Starkie (5) did a very interesting study on exercise just prior to an injection of e. coli, which totally attenuate the TNK-a sickness response.

      I suspect that you may find high and low IL-6 responders in a study of exercising patients receiving chemotherapy. How important might that be regarding treatment outcomes or treatment side effects, including sickness behavior? However, Ostrowski’s study finding high & low responders (7) occurred after 2.5 hours of exhaustive treadmill running, so no difference may be found with shorter less intensive training in cancer patients while receiving chemotherapy. But they also found no changes in IL-1b or TNF-a.

      Another interesting IL-6 finding was by Margeli (8) after the Spartathlon, a 246 km race. IL-6 levels after the race varied from 700 to over 27,000 pg/ml (individual data, personal communications), which is well beyond the IL-6 levels induced by sepsis of ~ 7,000 to 8,000 pg/ml. Since these runners didn’t die and presumably only felt fatigued, and IL-6 levels returned to normal within 48 hours, could muscle IL-6 mRNA also contribute to some sort of processing mechanism during chemotherapy to reduce sickness response? While exercising during infusion? Muscle IL-6 mRNA content can improve with training (4), therefore, will you find a beneficial training effect on chemo induced sickness response? If so, more importantly, will treatment response rates be better? Can an IL-6 response be a biomarker of treatment response or sickness side effects?

      All of this, in my opinion, points to the value of exercise in the pre-habilitation setting prior to first chemotherapy treatment, or at least to the possibility of exercise’s value during chemotherapy infusion.

      Lots to investigate. I hope WorkOut Cancer can help to support investigative research like yours. If you have motivated patients who would like to raise funds for us please let me know! I will look up your study. Thank you for your reply, and for research efforts on behalf of cancer survivors!

      Ken

      1. M. J. Perko.  Mesenteric, coeliac and splanchnic blood flow in humans during exercise.  Journal of Physiology (1998), 513.3,  pp. 907—913.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231328/pdf/tjp0513-0907.pdf
      2. ROWELL L.B., Indocyanine Green Clearance and Estimated Hepatic Blood Flow during Mild to Maximal Exercise in Upright Man.  Journal of Clinical Invsetigation, Vol. 43,
      No. 8, 1964. http://www.jci.org/articles/view/105043/pdf
      3. Febbrario, M.A., et al., Hepatosplanchnic clearance of interleukin-6 in humans during exercise. Am J Physiol Endocrinol Metab 285: E397–E402, 2003.
      http://ajpendo.physiology.org/content/ajpendo/285/2/E397.full.pdf
      4. Bente Pedersen and Mark A. Febbrario. Muscle as an Endocrine Organ: Focus on Muscle-Derived Interleukin-6. Physiol Rev 88: 1379–1406, 2008.
      http://physrev.physiology.org/content/88/4/1379.full.pdf+html
      5. Rebecca Starkie, et al. Exercise and IL-6 infusion inhibit endotoxin-induced TNF-α production in humans. FASEB J. 2003 May;17(8):884-6. Epub 2003 Mar.
      http://www.fasebj.org/content/early/2003/05/02/fj.02-0670fje.long
      6. Elsea, C.R., et al. Inhibition of p38 MAPK Suppresses Inflammatory Cytokine Induction by Etoposide, 5-Fluorouracil, and Doxorubicin without Affecting Tumoricidal
      Activity. PLos ONE June 2008, Volume 3, Issue 6, e2355. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396285/pdf/pone.0002355.pdf
      7. Ostrowski, K., et al. A trauma-like elevation of plasma cytokines in humans in response to treadmill running. Journal of Physiology (1998), 513.3, pp. 889—894.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231318/pdf/tjp0513-0889.pdf
      8. Margeli, A., et al. Dramatic Elevations of Interleukin-6 and Acute-Phase Reactants in Athletes Participating in the Ultradistance Foot Race Spartathlon: Severe Systemic
      Inflammation and Lipid and Lipoprotein Changes in Protracted Exercise. The Journal of Clinical Endocrinology & Metabolism 90(7):3914–3918.
      http://press.endocrine.org/doi/pdf/10.1210/jc.2004-2346

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