Lessons Learned & Learning 12: 360 Days of Maintenance

Radiation Edition #2

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 update:
http://www.myfitnesspal.com/topics/show/1253362-lessons-learned-learning-4-120-days-of-maintenance
150-day update:
http://www.myfitnesspal.com/topics/show/1290642-lessons-learned-learning-5-150-days-of-maintenance
180-day update:
http://www.myfitnesspal.com/topics/show/1321007-lessons-learned-learning-6-180-days-of-maintenance
210-day update:
http://www.myfitnesspal.com/topics/show/1356923-lessons-learned-learning-7-210-days-of-maintenance
240-day update:
http://www.myfitnesspal.com/topics/show/1400014-lessons-learned-learning-8-240-days-of-maintenance
270-day update:
http://www.myfitnesspal.com/topics/show/1438678-lessons-learned-learning-9-270-days-of-maintenance
300-day update:
http://community.myfitnesspal.com/en/discussion/10003569/lessons-learned-learning-10-300-days-of-maintenance
330-day update:
http://community.myfitnesspal.com/en/discussion/10019907/lessons-learned-learning-11-330-days-of-maintenance

My twelfth 30 days looked like this:


Here's how the twelve 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.

This latest period marks my lowest 30-day average (146.7). Between days 331 and 360 inclusive my weight ranged from 145 (Nov. 23) to 148.5 (Nov. 30) and marks the second period in which every day fell below my goal weight. I continue to monitor, with an eye toward increasing my maintenance calories if I feel the need.

My exercise calories burned may be the key here. My MFP goal shows 1,980 calories/week, which rounds up to 283 calories/day. One glance at my average exercise burns for all twelve 30-day periods shows a roughly 100-calorie surplus. That's an excess burn of 700 calories/week, or enough to burn off a pound every five weeks (if calories consumed are held constant).

Bottom line: I'll see how I feel and what my body tells me.

Exercise Calories Burned:
I took 0 rest days during maintenance days 331-360, compared with 1 rest day (0 calories burned) during maintenance days 301-330, 1 rest day during maintenance days 271-300, 2 rest days during maintenance days 241-270, 1 rest day during maintenance days 211-240, 2 rest days during maintenance days 181-210, 1 rest day over days 151-180, 3 rest days over days 121-150, 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.

My average exercise calories burned for this period equaled 420/day, with the highest burn being 454 on Dec. 11. This marks the highest 30-day average burn.

Total and Net Calories Consumed:
Total calories for maintenance days 331-360 averaged 2060/day (my highest 30-day average) and ranged from 1811 (Nov. 21) to 2352 (Dec 4). Net calories (total calories minus exercise calories burned) averaged 1640/day and ranged from 1396 (Nov. 21) to 1934 (Nov. 12). This marks the second time my average net calories have been above goal (but see weight drop and increased exercise burn, above).

Cancer Update:

I am now done with active treatment (i.e., surgery + chemo + radiation). My last radiation treatment occurred on Dec. 5. I've had some burning and blistering, but am healing nicely and quickly. My breast looks worse than it feels -- at the end, I would rank my pain a 2 out of 10, with an occasional tick up to 3 on that last day and the day after. By Dec. 10 I felt no pain at all.

I finally photographed the plastic cast tailored to my body shape. This cast had held me in the same position through all 33 treatments:



My head rested in the center depression. My left arm rested in the curved track and I held onto the white peg.

My final week of radiation involved the "boost" phase of my treatments: radiation aimed specifically at my tumor bed. (More info at http://www.breastcancer.org/treatment/radiation/types/ext)



This cage is attached to the linear accelerator. The cage holds a small mold whose opening size matches the new markings made on my breast, to guide the electrons used in the boost. Both the mold and the plastic cast can be recycled and reused.

This last phase of radiation treatment went considerably more quickly than my earlier treatments. During each of the five boost days I received a single zap to just one spot defined by the mold, rather than a series of zaps to 11 separate fields.

Maintenance day 360 marks eight full weeks since my last chemo infusion. My blood protein is finally back to normal (yay!), though I still have a couple of abnormal readings. My white blood cell count (immunity) is back down a bit, likely due to radiation, but that should now resolve. My next lab work will be in January.

I'm still dealing with a bit of fatigue and am being careful getting out of bed again. Seems my vertigo hasn't left me completely; fortunately, my one fall sent me back on my butt on the bedroom carpet. Just a touch of my metallic chemo mouth remains and is most prominent when I need food or water; I continue to add lemon juice to the latter.

I am now off Prilosec and on generic Arimidex (anastrazole), which I will continue to take for at least five and likely ten years. Arimidex is an aromatase inhibitor (AI). My tumor had been hormone receptor-positive. Even though I am post-menopausal, my adrenal glands still produce estrogen. Estrogen is food for the type of cancer I've been fighting; I am on the AI to try to prevent cancer recurrence.

According to Breastcancer.org, "Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells." (http://www.breastcancer.org/treatment/hormonal/aromatase_inhibitors)

I am also taking calcium because bone loss is a potential side effect of Arimidex. I learned at my breast cancer support group that taking Arimidex before bed helps guard against other potential side effects like bone and muscle pain. There's variability here, too -- a friend of mine had experienced no negative side effects from Arimidex at all over the five years she had taken it.

I've also read accounts like the one from Nancy Stordahl, who writes, "Shortly after I began taking Arimidex, sleep issues due to leg pain and leg cramps (to name a couple) started up. Aches and pains in my joints/bones became significantly bothersome 24/7. I began to feel like an eighty year old woman when trying to get out of my car, rise from a chair, sit through a movie or just move around period. In addition, quite quickly after beginning on the drug I gained fifteen pounds (am I actually admitting this so publicly?) Last winter I was diagnosed with osteopenia (bone health previously was excellent) and this spring it became nearly impossible for me to walk to the stop sign at the end of my street because of the crippling effect on my feet and toes. Before the drug, I was used to walking two to four miles a day by the way." (http://nancyspoint.com/the-dark-side-of-aromatase-inhibitors-part-2/)

Obviously I hope my experience is more like my friend's. I have also read that in many cases side effects like bone and muscle pain lessen considerably after the first three months or so.

Then there's the recent finding reported in the Journal of Clinical Oncology that aerobic exercise and strength training decrease pain from AIs. (http://www.cancernetwork.com/news/exercise-reduces-ai-induced-joint-pain-breast-cancer-survivors) I am slowly returning to strength training (in a way that does not court lymphedema), so I hope that works in my favor. The bottom line is that endocrine therapy is like any other cancer treatment, in that no two experiences are alike and they can cover a broad range of possibilities. I'll take each day as it comes. Weight gain is another side effect reported with Arimidex.

If that weren't already enough to motivate my exercise, there's this finding from research performed at the University of North Carolina: "Mortality rate is reduced by 34% after breast cancer diagnosis for individuals with higher levels of reported physical activity, compared with those with the least amount of physical activity." (http://www.medicalnewstoday.com/articles/277848.php) You might say I'm pedaling for my life.

My hair regrowth continues:



I did "Emerging" out of a sense of renewal as I neared the end of active treatment: