Lessons Learned & Learning 5: 150 Days of Maintenance

Ejourneys

Chemo Edition #1

My 30-day maintenance update is here:
http://www.myfitnesspal.com/topics/show/1176760-lessons-learned-learning-first-30-days-of-maintenance
60-day update:
http://www.myfitnesspal.com/topics/show/1202553-lessons-learned-learning-2-60-days-of-maintenance
90-day update:
http://www.myfitnesspal.com/topics/show/1228283-lessons-learned-learning-3-90-days-of-maintenance
120-day upate:
http://www.myfitnesspal.com/topics/show/1253362-lessons-learned-learning-4-120-days-of-maintenance

My fifth 30 days looked like this:



Here's how the five 30-day periods compare:


Weight: I had reached my goal weight of 150 lbs. on Dec. 17, 2013. According to MFP, that would place my net calories at 1600 for maintenance.

Between days 121 and 150, my weight ranged from 147.5 (May 4) to 155 (May 9, the day after my first chemo infusion). My average weight was 149.9. I had shot up 5 pounds overnight due to edema, constipation, and steroids after my infusion, but those all resolved in about a week.

Exercise Calories Burned: I took 3 rest days (0 calories burned) during maintenance days 121-150, compared with 5 rest days over days 91-120, 3 rest days over days 61-90, 4 rest days over days 31-60, and 2 rest days over days 1-30. Rest days for this period included April 28 (the day of my MUGA scan to check my heart -- that normally wouldn't stop me from exercising but it was just a busy day); May 6 (the day of surgery to have my chemo port installed); and May 8 (first chemo infusion).

My average exercise calories burned for this period (including rest days) equaled 351/day. Maximum number of calories burned in a day equaled 955 (weed-whacking plus planks on April 19). Following my first chemo infusion I resumed exercising at a lower intensity and gradually built that up as my side effects lessened. (By Day 151 I had returned to pre-chemo intensity.)

Workouts on the DeskCycle constituted my main exercise during this period. Planking is on hiatus again following a brief return, mainly because chemo makes my skin more sensitive, including to the friction that occurs from muscle vibration during planks. Chemo also reduces my immunity, so I have to be extra careful to avoid cuts and scrapes. Other forms of exercise during this 30-day period included walking, cleaning, and yard work. From here until the end of treatment, my yard work will be curtailed as well because of added sensitivity to sun. My instructions are to use sunblock of SPF-50 or greater when outdoors. I could feel the difference in sensitivity even during a half-hour drive on a sunny day.

Total and Net Calories Consumed: Total calories for maintenance days 121-150 averaged 1789/day and ranged from 1245 (May 8, the day of chemo infusion) to 2329 (May 5, the day prior to surgery to have my chemo port installed). Net calories (total calories minus exercise calories burned) averaged 1437/day and ranged from 858 (April 19, the day of my 955-calorie burn from weed-whacking) to 2193 (also on May 5).

I made a concerted effort to increase my calorie intake prior to chemo because I knew it would depress my appetite. Total calories during this maintenance period on the days prior to chemo averaged 1849/day (1460/day net), compared with 1623/day (1374/day net) from the day of chemo on.

That said, my average net calories, even if I were to use only the days leading up to chemo, still fall below MFP's maintenance of 1600 net. Net calories for the entire 30-day period come to 90% of the MFP recommendation. Net calories for the period prior to chemo come to 91.25% and those from the day of chemo on come to 86%. By the end of this 30-day period my appetite had returned to normal and my net calories on Day 150 clocked in at 1653 -- 53 calories over maintenance.

Cancer Update: At the time of my prior update, my surgeon and I had hoped that I would not need chemo. However, my Oncotype DX score fell into the intermediate range, which, combined with my age, recommended chemo. Specifically this means four infusions of Adriamycin and Cyclophosphamide. Unless my blood work indicates otherwise, I will receive one infusion every three weeks.

One down, three to go.

Then, depending on how my body responds, my oncologist and I will determine whether or not I continue with 12 once-weekly infusions of Taxol. Once chemo ends, and after a rest period to let my body recover, I will continue with radiation and hormone meds.

Thanks to anti-nausea meds, my nausea from infusion remains minimal, resolved with sips of water, small bites of food, and movement. My constipation eventually resolved with the help of prune juice and a smoothie modified from this recipe:
http://healing.answers.com/remedies/cure-your-constipation-with-a-fruit-smoothie
(I had used 10 prunes, half a banana, 1/2 cup of applesauce, and a cup of plain Greek yogurt, in addition to water). Likewise, my edema gradually resolved. Other side effects include brief touches of peripheral neuropathy, skin sensitivity, and dry mouth. My water consumption is at least 10 glasses per day, because chemo dehydrates the body something fierce.

My main side effect has been fatigue. I had been warned that chemo can create sudden, bone-crushing fatigue, and that description is accurate. Two days after infusion (and one day after I received a Neulasta shot to rebuild my immunity), I needed two 4-hour naps in addition to overnight sleep. I needed two 2-hour naps on day three, one 90-minute nap on day four, and two 1-hour naps on day 5. By day 6 my baseline energy level had returned.

Exercise combats both fatigue and nausea, as well as edema. It also helps build immunity. The day after chemo infusion (and while i was still hopped up on steroids), I pedaled an easy 11.2 miles in 66 minutes on the DeskCycle. Succeeding days clocked 60-minute workouts covering 13.2, 12.9, 14.1, 15.5, 16.5, and 16.6 miles.

We still need more data to determine my immunity curve, but immunity typically falls to its lowest level about a week after infusion. By that time the Neulasta shot kicks in to raise immunity levels back up, until the next infusion knocks them down again. A week after my first chemo infusion, preliminary tests showed almost everything still within normal range (though clearly changed from my pre-chemo baseline). The only outlier was my white blood cell count, which had been a bit low prior to chemo and which has remained mostly unchanged.

May 14 marked my first excursion away from the house since my Neulasta shot on May 9. I created and wore this as my fashion statement:



I need to avoid crowds, anyone with a cold or flu, and anyone who has been recently immunized. Frequent hand-washing and use of hand sanitizer have become part of my daily routine. I attached my badge with paper clips rather than a pin because I need to avoid cuts and scrapes (and immediately apply antiseptic and a clean bandage if I get one). It all means I forego my usual hugs and handshakes. Also, the shirt pictured here has long sleeves, which I need to wear outdoors to protect my skin.

I have not yet lost my hair, but that's coming. I expect to be bald by the time of my next maintenance update, and am already prepared with some spiffy chemo caps.

PJPrimrose

Go you! One heck of a journey there! I don't know if I could maintain as well as you have. I'm so impressed!

themedalist

There are no words. With all you are dealing with cancer-wise, your attention to maintaining your weight and good healthy habits is most impressive. And since a healthy diet and exercise helps our bodies in so many ways, I'm sure it's helping you fight cancer. Plus. I'm sure it's a welcome distraction from the cancer treatment regime.

Best wishes! I look forward to your next update and as a fellow data lover, the graphs are GREAT!!!!