Every time we see ourselves with compassion, we have made a giant step forward.
—Cheri Huber, The Fear Book
If you or a loved one have ever been through a healing crisis, you know how each aspect of that journey—from diagnosis to long after treatment—had its own particular timing, needs and challenges. Certainly this applies to breast cancer, as I learned first as an oncology nurse at a Boston teaching hospital and then as a breast cancer patient. I wish I knew then what I know now.
In this article and in my workshop at the KYTA conference, I hope to deepen your awareness of some of the particulars of the "breast cancer journey" to help you better serve yoga students, friends or loved ones in need of support.
Let's begin by taking a look at the allopathic treatments your students may undergo at various stages. The more you know about what each involves, the better your anatomical understanding of how they can impact range of motion, energy, body image and comfort and pain levels.
Local treatment (affecting only a particular body area) includes
- Wide local excision biopsy—removes the tumor and some tissue around it
- Axillary lymph node dissection—removes lymph nodes under the armpit.
Swelling of the arm and hand of the side where the nodes are removed can be a serious complication.
- Mastectomy
1. Modified radical—removes the whole breast and axillary lymph nodes
2. Simple—removes just the breast tissue, including nipple and areola
3. Radical—removes breast, axillary (and sometimes supraclavicular) lymph nodes and pectoralis muscles
- Radiation therapy—high dose light beam X-ray to a specific area. Often continues for four to seven weeks, five days a week.
- Reconstruction—an optional procedure, now covered by most insurance companies, using implants or one's own tissue to rebuild the breast. The "self-donation" method is usually called a "tram" or "diep flap" procedure. Dr. Robert Allen's web site at www.diepflap.com has a description and photos. Working with women who have a tram flap procedure takes special awareness as it usually involves disconnecting one of the rectus abdominus muscles from the pubic bone.
Systemic treatment (affecting the entire body) includes
- Chemotherapy, in pill or intravenous forms, delivered to the body via the blood system. Some of the medicines used make the person more susceptible to infections and the loss of hair. If a "port" is used, you will notice a one-inch round bump under the skin of the upper chest; this is a container into which chemo is given and/or blood is drawn, sparing the veins in the arm from multiple sticks. The port is attached to a small tube inserted into the vena cava and sewn to the pectoral muscle for stability.
- Hormonal therapy, usually in pill form, e.g., Tamoxifen or Femara, which block estrogen from getting into the system. Some women have their ovaries removed instead.
General guidelines for teaching yoga to women in and after treatment
- Do not assume you know how a woman is feeling or what she is capable of. Ask about limitations and concerns, with quiet respect for privacy.
- Encourage your students to be vigilant in listening to their body's wisdom, personal timing and pace, and to honor and follow it. Our culture is not one that supports much "down time." Be a voice that supports this need. Encourage patience, ahimsa (non-violence) and karuna (compassion). Healing has a time of its own and everyone's journey is unique.
- Rest and recovery time are essential to healing. Encourage longer sleeping time, naps and relaxation poses. The practice of gentle and restorative asanas, integrating pranayama, mind-calming meditations and visualization, can be a huge help in recovery—a place of refuge and hope. These include yoga nidra, savasana, Mountain Brook/Fish, Reclining Bound Angle and resting the legs up the wall or on a chair. Judith Lasater's Rest and Renew is an excellent source for detailed instructions.
- Encourage your students to proceed slowly, gently and in small increments. A daily practice that intensifies gradually can bring returned flexibility and strength in a very short time. Warming the muscles with a shower or bath before practice eases movement.
- Encourage movement and stretching with intention and attention. Hold each pose for three to five breaths. Feel the edge of the stretch without pushing through it. Help your students to ride the wave—?breathe, relax, feel, watch, allow.
- When movement feels impossible or progress seems stalled, help your student to visualize what it felt like when the actual pose or movement was possible.
- Being a good listener is more important than giving advice. Be a loving, nonjudgmental witness to your students' experience. Love is the most potent healer of all.
- Remember that healing is a body-mind-spirit process. It may or may not include a "cure."
For students in the first few weeks after treatment, focus on small movements with awareness and breath rather than postures that require strength or opening in the arm, shoulder and chest areas (or abdominal strength, for those who have had a tram flap reconstruction procedure). The resistance/release process, i.e., first activating and shortening the muscle(s) needing relaxation and then elongating and stretching, can be helpful.
Appropriate warm-ups and stretches
Shoulder shrugs: Lift shoulders up toward ears, hold and release, repeat twice.
Figure eights/circles: Step forward with the left foot, bend at the hips, place the left arm on the left thigh and let the right arm relax and dangle from the shoulder. Make small circles with the right arm, increasing in size. The movement is similar to that of swishing your hand around in a pot of water, without effort.
Wall climbing: Standing at a wall, face the wall directly and then turn so that one shoulder is next to the wall. Walk the hand next to the wall up toward the ceiling and back down. Repeat two to three times, then repeat the sequence on the other side. Note how far you "walk" each day to watch your progress.
Modified half dog: Face the wall, with your hands on the wall at approximately shoulder height. Slowly walk your feet away from the wall. Stop and breathe into the first edge of the stretch. Increase the stretch over time.
Alternate hand lifts: Lying on the back with the arms by the sides, lift the right hand up toward the ceiling and then backward down toward the floor as far as is comfortable. Return the hand to the starting point. Reverse. Repeat several times on each side. Try to initiate the movement from the shoulder blades.
Snow angels: Lying supine and starting with the arms beside the body, elbows bent, slowly sweep the arms out to the sides, up over the head and back down. It will take time to increase the range of movement, so go easy. In the beginning, it's best to do one side at a time, focusing attentively and staying within the range of comfort.
Suggested pranayama
Dirgha breath
Letting-go breath [Inhale through the nose; soft audible sigh on exhale]
Balancing breaths (ujjayi and nadi shodhana)
So ham ("I am") breath ["so" on inhale, "hum" on exhale]
Resources
Videos
Kripalu Gentle Yoga with Sudha Carolyn Lundeen
Yummy Yoga with Christa Rypins
Yoga and the Gentle Art of Healing with Susan Rosen
Yoga for Healing Breast Cancer with Esther Myers
Yoga for Relaxation (restoratives) with Patricia Walden
Books
Prepare for Surgery, Heal Faster by Peggy Huddleston (audiotapes available)
Rest and Renew by Judith Lasater
Somatics by Thomas Hanna
Yoga Nidra and Mudras: Handbook for Healing by Richard Miller
The Healing Path of Yoga by Nischala Joy Devi
The Fear Book and There Is Nothing Wrong with You by Cheri Huber
Breast Cancer, Breast Health by Susun Weed
Places That Scare You by Pema Chodran
The Breast Book by Susan Love
Healing into Life and Death and A Year to Live by Stephen Levine
Audiotapes
Healing Meditations with Sudha Carolyn Lundeen and Dayashakti Scherer
The Only Real Thing and For God Alone with Mark Kelso
Yoga Nidra, November 2002 KYTA resource tape with Diana Damelio
Yoga Nidra with Shiva Rae
Yoga Nidra with Richard Millar (also in booklet form)
Retreat centers and Web sites
Smith Farm Center for Healing, Washington, D.C., www.smithfarm.com
Commonweal Cancer Help program, Bolinas, Calif., www.commonweal.org
Gilda's Club, www.gildasclub.org
Share, www.sharecancersupport.org
Expedition Inspiration, "A HREF="mailto:ei@expeditioninspiration.org">ei@expeditioninspiration.org or 208- 725-2091
Casting for Recovery, 800-533-3500
Imaginis.com (research, chat lines, resources)
Breastcancer.org
Sudha Carolyn Lundeen, a 20-year breast cancer survivor, leads workshops on yoga, healing and meditation throughout the U. S. and Canada. A former gyn/oncology and Breast Cancer Education nurse in Boston, Mass., she is a Healing Coach specializing in helping women navigate the journey of breast cancer. Sudha will offer the workshop Teaching Yoga for Women during and after Treatment for Breast Cancer at the 2004 KYTA Conference, Oct. 21 to 24. For more information, contact her at sudhadeen@aol.com or 413-448-3400, voice mail #747.
