Rope-a-dope and cancer – don’t punch yourself out.

 

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Boxing was a big deal when I was growing up, and the brilliance of Muhammad Ali’s boxing strategies stand out: ‘crazy man’ against Sonny Liston; and, ‘rope-a-dope’ against George Foreman are my favorites.  Getting into the heads of his formidable opponents gained Ali an edge, and the wins, but it also highlighted something important, effort is not everything, knowing when to give it all is.  If you want to win a marathon you don’t run the first mile as fast as you can, measured patience is valuable, thinking things through is important.

I think many cancer patients can learn from Ali’s strategies.  It’s often heard, and it may be the only frame of reference that newly diagnosed cancer patients have going into their first treatments, ‘I’m fighting hard against cancer’, and Jim Valvano’s ‘Don’t give up, don’t ever give up’.  Worthy mantras for sure, attitude is important.  However, Ali exploited a similar mindset in 1974 when fighting George Foreman for the heavyweight champion of the world in the famous Rumble in the Jungle in Kinshasa, Zaire.

Ali let Foreman punch him round after round, absorbing the blows while leaning back against the ropes, guarding his body and face with his arms and gloves.  The undefeated Foreman eventually grew tired, punched out, and Ali then came off the ropes and knocked  Foreman out in the eight round.  Ali strategized NOT to stand toe to toe and match brute punch with brute punch.  Instead, Ali exploited Foreman’s aggressiveness to his own advantage, until George was tired and vulnerable, then Ali was able to quickly finish him off for the heavyweight title.  As the fight was developing Ali was being criticized and questions for how he was, or was not, fighting, but he knew exactly what he was doing, and it worked perfectly.  Ali went against conventional thought and won.

Can cancer patients learn from this?  Perhaps.  Cancer patients can beat cancer but lose the battle to an infection due to their weakened physical condition.  Can exercise help, probably.  Can considering how to fight help as well?  I say yes.  I have an example from one of my own treatment experiences.

I had heard about bone pain associated with Neulasta (Pegfilgrastim), a common drug given to chemotherapy patients to boost their white blood cell counts and to help prevent infection.  After receiving my first injection of Neulasta I waited for the bone pain to start.  After a few days I didn’t have any pain, I felt lucky.  However, on the third day, while driving to complete some errands, I started having pulsing pain in my pelvis.  I thought, pelvis, a large flat bone that produces blood cells, this makes sense.  The pain would pulse stronger with each heart beat, for about 8 beats, then it would subside for about another 8 beats, giving me welcome relief from the pain before repeating this cycle.  It must have frightened other drivers to see me gripping my steering wheel with white knuckles, grimacing hard, and shouting out.  I wasn’t working on Ali’s ‘crazy man’ strategy either.  Good thing they couldn’t hear me in the car!

When I got home I called the oncology clinic to tell them about the pain and to find out what I should do.  I was told to use some Tylenol, which blunted the pain, although I could still feel the pulsing going on.  Ok, this is part of dealing with cancer and cancer treatments.  Tough it out, I’m fighting cancer I thought.  That night the pain moved from my pelvis to my sternum, another flat bone, makes sense.  I thought my femur (the head of long bones produce blood cells too) might be next.  However, the experience of the sternum pain was different.  Although the pain was blunted, I started feeling my blood pressure drop and I got some mild chills and shakes.  This concerned me since I was already laying down, and the direction my blood pressure was headed, lower, wasn’t a good direction.  I didn’t tell my wife, something common between cancer survivors and their caregivers, since she had just fallen asleep, but I was concerned about whether I would wake up if I fell asleep.

The next morning, a day ahead of schedule, I went to see my oncologist.  He listened to me give all the details about how I was doing, then he started backing to the door signaling that our session was over.  He had just put his hand on the door handle when I mentioned the chills and shakes from the night before.  “That was the most important thing you’ve said, I think you have a bone infection.”  He started me on an antibiotic infusion, and half an hour into the three-hour infusion I felt completely better.  I had been walking around with a bone infection and I had thought it was just part of the pain from the Neulasta shot.  What might have happened had he left the appointment not hearing about the chills and shakes?  The Tylenol was masking the pain and I accepted the pulsing in my bones  as part of fighting cancer.  I was rope-a-doping myself – fighting with maximal effort, being tough, accepting the pain, when I may have been on the verge of being knocked out, maybe even for good.

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So, for all you tough, stubborn, cancer fighters out there, keep it up, but also be willing to sometimes consider backing off and redirecting your efforts.  And for those of you who have been putting off getting that lump or mole checked out, or if you have not had a physical exam in years, get in there!  Don’t rope-a-dope yourself before any fighting even begins, and set aside time each week to improve your fitness, if you have to fight, it’s better to be physically ready for it.  It is no fun getting a prostate exam or colonoscopy, but dropping your drawers, bending over, and taking it up the backside can be a winning strategy.

 

Chemo man brain … it ain’t pretty!

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The male brain is odd enough (I heard those amens ladies!), apply some chemotherapy to it and the results can be, well, let’s just be kind and say … interesting.  A typical generalization is that men are driven to solve problems while women are motivated by emotion.  Us guys try to fix things, that’s what we’re wired to do.  Note the word ‘try’, because we’ve been known to make things worse (I know ladies, I know).

One of my favorite stories is from the book  And In Health by Dan Shapiro, PhD.  On pages 143-144 Dan tells the story of a couple talking, then laughing, about how lucky they were when the chemo brain affected husband nearly burned down their house after forgetting he was cooking something on the stove.  The lucky part was that the overflow from the bath he forgot he was running upstairs crashed though the ceiling and put out the fire.  I laughed until I cried at that story.  Check that off the bucket list.

My story is not nearly as dramatic but is probably not uncommon for the types of distorted plans men can come up with under the influences of chemo brain.  As patients, we are given time between chemo cycles so our bodies can repair before the next toxic assault.  Well, tumors are a part of the body and they can regrow and repair between chemo cycles too, some drugs may even contribute to that process.  I wasn’t about to let that happen without the potentially ‘normalizing’ affects of exercise, which I hypothesized would influence, in my favor, any regrowth or repair that my lymphoma tumors might be trying to do.

After my chemo cycles I often had low blood pressure, which caused me to become dizzy from standing up.  A cancer specialist physical therapist told me a technique of pumping my legs before standing up to raise my blood pressure.  This helped.  However, that first day home, I was concerned that my plans for walking on the treadmill might be dismantled by my low blood pressure, so I fired up the chemo man brain for a solution.

I decided I would text my wife ‘ok’ every 5 minutes while walking on the treadmill.  If she didn’t get a text then she should call the EMTs.  Great plan I thought, some of you guys are agreeing while others are already improving on the man plan – you should have done ‘face time’ or done such and such.  The other brains, women’s, are rolling their eyes, just like my wife did at work while she and her colleagues agreed that my plan was the dumbest they had ever heard of.

The walk went well.  I actually felt better since my blood pressure increased due to the physical exertion.  Afterwards I continued to feel better than before the ‘workout’ (1.36 miles on treadmill at a max of 2.7 mph & 0% grade for 30 minutes – slowest of my life).  When my wife came home that evening she reiterated the stupidity of my plan.  “I had the front door unlocked for the paramedics” I told her.  “Well you forgot to tell me that” she replied, as if it even mattered.  “Why didn’t you just wait until I came home from work?” she asked.  “I didn’t think of that” I replied.  D’oh!  Chemo man brain.

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If you have a chemo man brain story I’d love to read it.  Post a reply!  Thanks!

References:

Therapy-Induced Acute Recruitment of Circulating Endothelial Progenitor Cells to Tumors.  Shaked, Y., et al.  Science 313, 1785 (2006): DOI10.1126/science.1127592 http://www.sciencemag.org/content/313/5794/1785.full.pdf

NORMALIZATION OF THE VASCULATURE FOR TREATMENT OF CANCER AND OTHER DISEASES.  Goel S., et al.  Physiol Rev 91: 1071–1121, 2011 doi:10.1152/physrev.00038.2010  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258432/pdf/nihms348021.pdf

Physical activity and tumor vessel morphology among men with prostate cancer.  Van Blarigan, E., et al.    http://mb.cision.com/Public/3069/9520261/82b38a3d9391d0bb.pdf

Exercise modulation of the host-tumor interaction in an orthotopic model of murine prostate cancer.  Jones, L.W., et al.  J Appl Physiol 113: 263–272, 2012.

And in health A Guide for Couples Facing Cancer Together.  Dan Shapiro, PhD.,  First Edition, Trumpeter Boston & London 2013,  ISBN 978-1-61180-017-3 (pbk.)

You can find out more about Ken’s treatments and training here.