Flexibility and core strength pave the way for pain-free weight training

I have been training heavily for the past few months since the bodybuilding show last August.  I am in a "building" phase, which means I am working toward building muscle strength and mass through my workouts and my diet.

About six weeks ago, I started developing low-back pain and stiffness.  A few weeks after that, I began to experience "tennis elbow", or pain in my left elbow area whenever I used that arm to lift weights.  After talking it over with Domenick, I came to see that I was not spending enough time warming up before lifting and I had stopped training my core (abdomenals, obliques and lower back muscles) as intentionally as I had the previous summer.  While a younger weight trainer might be able to get away with less flexibility and core work, a 46-year-old cancer survivor cannot.

I began adding 20 extra minutes of flexibility training to my workouts.  I was already spending 15 minutes at the end of each workout performing stretches, but I needed more.  Domenick encouraged me to add joint rotations to my warm ups and in between sets.  Since there is a rest period between sets when I am lifting, this is an ideal time to do joint rotation exercises.  Seven days a week, I am performing joint rotation and static stretches.  On days that I am not weight training, I simply do the rotations as a warm up to my cardiovascular work that day. 

I've also added a concentrated core training workout on the two days a week that I am currently just doing cardiovascular exercise.  I perform a varying series of abdomenal, oblique and lower back training exercises for about 15 minutes after my cardio work.

The great news is that my lower back pain and stiffness have completely dissappeared!  To be honest, I didn't think the pain would go away that quickly, but I am thrilled that it has.  My "tennis elbow" is still with me, but I continue to work on that through stretching, rotations, self-massage and some strength training for my wrists and forearms.

My 4-minute documentary on Momversation.com

Over the summer, I made a four-minute documentary of my story for a special series called Her Story for the website momversation.com.  Well, it has finally been posted!  Here's the link:


http://www.momversation.com/herstory/ministers-wife-body-builder


Making this documentary was a great opportunity for me and my son, Sam, to do something positive in response to my cancer and treatment.  My illness was hard on him.  At age 11, he's old enough to understand the seriouness of cancer and that people die from it.  Making this film was a positive experience in response to it, and it tapped into his technological gifts.  He did most of the filming. 

My Story in the Philadelphia Inquirer 9/27/2010

I was honored and grateful to be able to have my story told by columnist Art Carey in the Philadelphia Inquirer.  He tells it well, and I am happy to share the link with you:

http://www.philly.com/philly/health_and_science/20100927_Celebrating_her_body.html

What I eat and why

One of the hardest things about body building is the diet.  Several weight trainers have said to me that they think dieting is harder than resistance training, and I can see why.  It takes a tremendous discipline to count and limit carbohydrate, fat and protein grams, and to do it for long periods of time.

I have also noticed that many body builders fall into (what I consider) unhealthy diet traps.  Some don't eat carefully for much of the year and then have to lose a lot of excess fat in a short amount of time prior to the competition.  Others believe and follow dieting practices that aren't sound or supported by research.  This would include excessive supplement use, extreme carbohydrate restriction, and dehydration prior to the event.  The only supplement I use is a whole-protein, whey-based powder that I mix with water and drink after I weight train.  While I limit my carbohydrates, especially prior to a competition, I eat at least 130 grams a day at my lowest level.  At the specific advice of my nutrition coach (and professional body builder and trainer) Joe Franco, I did not limit my water intake prior to the competition.  Dehydration is dangerous and not necessary, according to Joe, if you have dieted well.  I agree with him 100%. 

During the two months prior to my competition, I tracked every bite of food that I ate and was careful to keep my carbohydrate, protein and fat grams within levels recommended by my nutrition coach.  I weighed and measured myself each week, and he would adjust his recommendations so that I was losing weight slowly (about 1/2 or 1 lb a week) prior to the show.  The goal was to lose body fat (for a very lean look on stage) without looking gaunt.  By the week prior to the show, my body fat was 16% (down from 19% the previous January).  For this next competition, I will probably begin the weight-loss process earlier, as I wasn't quite lean enough for the show I just completed.

My daily dietary staples included:  steamed white fish (tilapia, haddock), canned white tuna in water, sliced turkey breast, plain non-fat Greek yogurt (with some Splenda and cinnamon), lots of low-carb vegetables (salad greens, bell peppers, broccoli, zucchini, mushrooms, onions, celery, tomato, spinach), egg whites, low-carb diet wheat bread, and Special K Protein Plus cereal.  In smaller amounts, I ate peanut butter, olive oil, cantaloupe, and other breads/cereals/grains.  I cooked and baked my own food to ensure that it did not contain sugar and excess oils.  As a treat, I created an Angel Food cake recipe made with Splenda.  It was not as fluffy as the kind made with sugar, but it satisfied my sweet tooth many evenings at a mere 9 grams of carbohydrate per slice and no fat.  I found that I preferred to eat low-carb foods in greater quantities, rather than higher carb foods in smaller quantities.

Now that the competition is over and I am preparing to compete again next year (in 11 months), I am training hard and still watching my diet carefully.  I still follow the same eating pattern as above, only I eat a little more food to ensure that I maintain weight instead of losing it.  I also allow myself a few treats each week so that my diet doesn't feel too rigid.  I competed at 137 pounds and am finding it comfortable to maintain 140 pounds as my "off season" weight.  My nutrition coach has (wisely) recommended that I not gain too much weight in the off season, as it just means I have more to lose prior to the next competition.  I didn't want my weight to fluctuate much, anyway.  I find that, as I get older, it's much harder to lose weight.  I also don't want two wardrobes for my body at two different sizes.

During the off season, I am not logging every bite of food I eat.  I tried that for a few weeks, but it was tiresome and felt like a burden.  I always come back to the fact that body building is a hobby for me and something I do for fun and fulfillment.  So instead, I am making sure I eat enough protein (150 grams a day), limiting my fats to 50 or fewer grams a day and weighing myself on a daily basis.  As long as my weight stays around 140, I figure I am eating the right amount of carbohydrates and calories.

It is hard some days to stay with the diet plan, but I am motivated to do so (most of the time).  I like how I look, but I also like how I feel.  Following this lean protein and vegetable-based diet makes me feel good and helps control my irritable bowel syndrome (yes, I suffer with IBS as a result of the cancer treatment).  It minimizes the bloating I can sometimes feel.  It has also taught me to recognize when I am eating to cope with negative emotions (stress, most of the time).  Now, I stop and relax rather than eat, which is much healthier for me.

Plans for my SECOND competition in August 2011!

I've received some good feedback from my first competition.  Here's a short list of what I did well and what needs to improve:

Strengths:  Symmetry and proportions, abdomenals, side pose, hair and makeup, legs have good potential

Areas to improve:  overall size, leanness, darker tan, walking and posing, creating v-taper in my back

I have decided to compete in this same competition next year in August 2011.  That gives me a whole year (without any cancer treatment or surgery) to work on it.  I will work with Joe Franco, the event organizer, who also provides complete training and coaching for figure competitors.  I received my first set of nutriton and training guidelines from Joe today and will begin following them tomorrow, Sunday, September 12, 2010.

I feel good and did not experience a "rebound" (i.e. bloating, weight gain) from the competition.  My weight is within 3 pounds of what I weighed on competition day, and it's two weeks later.  I attribute this in part to Joe's excellent nutrition coaching for me.  We didn't do anything extreme that I would rebound from.  I stayed hydrated and my weight loss was slow and careful prior to the show. 

The Day After the Competition

Well, it's Sunday, the day after my first figure competition.  Wow!  It was a wonderful experience.  Let me tell you about it...

I arrived the night before the competition to check in and have a polygraph test.  I appreciate OCB's commitment to a drug-free show, so we all had to take polygraph tests and winners had to provide a urine sample at the end of the show.  My self-tanning wasn't working out so well, so I found a woman at the hotel on Friday night who was providing a tanning service and had her apply a coat of Jan-Tana to me.  (I learned that Jan-Tana works much better on me than does Pro-Tan.)  I met a few other contestants while waiting for the polygraph test and we had fun talking and sharing notes.  I saw Lindsley from my posing class and met Barbara, who is 53 and looks like she's 33 (a walking advertisement for the benefits of weight training for women as we age!)

On Saturday morning at 8:45 am, I joined about seven other women backstage who were waiting for make-up pro Tanya to apply our stage make up (including false eyelashes).  Tanya was fabulous and I LOVED my stage makeup.  Figure competitions are a unique blend of an athletic competition and a beauty pageant.  We were all pumping up before going on stage and eating our carefully prescribed foods at precisely the right times throughout the day, as well as making sure our suit bottoms were glued to our rear-ends (Bikini Bite) and our spray-tans were perfect. 

I competed in two categories - debut (for first-timers) and grand masters (age 45+).  I was nervous and excited, but mostly excited.  I felt very prepared (thank you Domenick and Joe!) and enjoyed posing for the judges.  It was hard work, but I was ready for it.

It was a long day, but time passed quickly as all the competitors performed in their rounds and the judges made their decisions.  It was a great feeling of comraderie out in the hall with the other contestants as we shared stories and experiences about training and our lives. 

Before I knew it, it was 5pm and time for the evening show.  In the show, each contestant performed a stage walk (approximately 90 seconds).  The announcer read my introduction and noted that I was a breast cancer survivor.  The crowd cheered and I felt my emotions making their way to the surface.   I thought "I can't cry yet!" and made my way onto the stage.  I was nervous, happy and proud all at the same time.  I managed to not fall off my shoes (!), even though I wobbled at one point.  As I walked off stage, I did cry for a few minutes, as the reality of having reached this important goal set in.


I remembered that a year ago at this time, I was in the middle of chemo treatments and a figure competition was still a distant dream that kept me going.  Finally being at the competition and completing the last portion brought a tremendous sense of closure to my whole cancer experience.  From my diagnosis, I had been saying "I'm going to compete in a figure competition when this is over".  So the competition became symbolic for my cancer treatment being over.  I felt free and victorious. 

On Sunday morning, I was so happy to be in church.  During the prayer time, I shared with the the congregation how much gratitude I felt toward God for enabling me to reach this milestone.  I felt strong, whole, healthy and beautiful.  Praise the Lord!

A few people have asked me how I placed and if I won any awards.  Awards were given to the top five contestants in each category, and I didn't win any awards for either of my categories.  I wasn't dissappointed by this at all; I didn't expect to win awards as a 45-year-old first-timer who just completed cancer treatment.  It was a major achievement just to know that I was fit enough to be up on stage and able to compete.  I felt like a winner just being there.

My training program

People have asked me how I've been training for this event, so I thought I'd offer a timeline of what I've been doing for the past year.  Here it is:

12 months prior

Last summer (2009), I knew I wanted to compete in a figure competition, but I didn't have a date in mind.  I was in the middle of chemotherapy and had radiation therapy and two surgeries ahead of me.  My primary fitness goal was to rehabilitate my body after each ordeal.  In between chemo treatments (and recovery from them), I would do a combination of resistance training, cardio training and stretching six days a week.  I did all of this at home, using equipment that I own.  Each day, I worked two or three body parts and did 3 - 4 sets for each part I worked.  I attempted to evenly train my whole body.  For cardio training, I either walked, ran (when I had the energy) or used my lateral slide trainer at home.  Flexibility was very important, I knew, and I did a 20-minute whole-body stretching routine once or twice a day, seven days a week.

6 months prior

By mid-January, 2010, I was beyond my last major surgery and knew it was finally time for me to begin training more specifically and intensely.  Over a period of a month, I built up to a training program that I followed for four months.  Domenick, my trainer, worked with me to ensure that I was making gains and having enough variety in my training program.  I trained one major body part a day, six days a week.  This was pretty intense, as I would do about 15 sets of 8 - 12 reps for each body part.  For example, on Monday, I trained my quads and hamstrings, Tuesday was arms (biceps, triceps, forearms), Wednesday was my back and shoulders, etc... In addition, I either trained my core (abs, obliques, low back) or my calves each day.  I added cardio training at the end of each workout for about 20 minutes.  This was a great program for me.  It was very challenging, but I experienced significant gains all over my body from it.

3 months prior

I had my final surgery in early June 2010, which kept me from training for about 3 weeks.  (I walked and stretched during this time, though.)  When I went back to training, Domenick had me focus especially on my weak areas.  He created two workouts for me:  weak points (3 days a week) and strong points (2 - 3 days a week).  My weak areas were my back, shoulders, chest and core, so I wanted to focus more on those.  I also had one day a week to just do cardiovascular training.  I also began learning to pose and practicing posing (seven days a week) at this point.

5 weeks prior

My workouts really kicked up a notch at this point.  The competition was drawing near and I needed to work even harder to be prepared.  I also began losing some body fat by dieting, which made the workouts even more challenging.  Four days each week, I did two workouts a day.  In the morning, I did moderate-intensity cardio training for about 40 minutes.  Later in the day, I would do resistance training.  Two days each week, I had only one workout, and it was an intense cardio workout with interval training.  I had one day a week to rest.  I followed this program until the week prior to the show, when the intensity of my workouts decreased.

Home vs. Gym workouts

I did at least half of my training at home, as it just wasn't an option to get to a gym on a regular basis.  Being a busy mom of young children, I needed workouts that I could do at home while I watched my kids.  We own a full set of Russian kettelbells, some dumbells, a TRX body resistance trainer (worth every penny!), a Reebok step and a Reebok slide, and  body bar.  Domenick and I were creative in figuring out how to use this equipment, plus furniture around the house.  I was pleased with how much I could accomplish at home.  In the gym, it was easier, of course.  I used the fitness lab in my department at school during the school year two days a week and my home equipment on the remaining days.  In the summer, I used my home equipment most of the time, but bought day-passes to gyms when I was traveling (for about four weeks).  I loved visiting different gyms and found it motivating to have new places to train with different equipment to try.

Overtraining and under-eating

At seven weeks before the competition, I realized that I had been training too hard and not eating enough.  The combination was leaving me feeling physically tired during the day, unable to sleep well at night, always craving something to eat, and lacking motivation for things I normally like to do (including training).  It developed gradually over 2 weeks, and it took me that long to recognize what was happening to me.  I imagine that someone else who was not familiar with these symptoms (I discuss the problem of overtraining in one of my courses) might go longer without recognizing them.

A challenge of bodybuilding starting about 12 weeks prior to a competition is figuring out the right balance of diet and exercise to maximize your msucle definition on stage.  You need to train to maintain the msucle you've built, but you also need to reduce your body fat to make the muscles more visible.  I am learning that it's a delicate balance and that everyone's body is different.  Another bodybuilder's diet and training plan at this stage might work well for him or her, but not for you, even if he or she is the same gender and similar to you in size and age.

 At about 9 weeks before competition, I had decided to slowly begin to reduce my carbohydrate intake and overall calories.  I had been eating 2,200 calories per day and ended up dropping to 1,800 per day, although I didn't have a specific calorie goal when I made the change.  My fat intake was already very low (less than 20% of my total calories), and I was attempting to eat 130 - 150 grams of protein each day.  I use a computerized diet tracking software to minitor these levels.  I also changed my training program at that point to two workouts each day instead of one.  I did 30 minutes of aerobic training in the morning (before breakfast) and my usual 60 - 80 minutes of resistance training in the afternoon.  I was also spending about 20 minutes a day posing.

Looking back, it makes perfect sense to me that I developed overtaining symptoms, but I didn't see it at the time.  I think what contributed to this lack of perspective was my fear that I would not be able to lose the amount of body fat I wanted to lose before the competition.  At 45 years old and having low estrogen (because of my hysterectomy and cancer treatment), it is harder for me to lose body fat.   Now, my current body fat is 19%, which is quite low for any woman and especially one at my age.  Many female bodybuilders compete at levels much lower, though, with some of the younger ones getting below 10% body fat.  This is not healthy in the long term and isn't my goal.  But my fear was that, if they are competing at 10 - 15% body fat, how will I fare at a much higher level?

I learned at least two valuable things from this experience.  First, I cannot obsess over numbers.  It doesn't matter what my percent body fat measurement is or how it changes; what matters in a competition is how I look (and equally important to me, how healthy I am).  It's easy to obsess over numbers as a bodybuilder; we do it concerning bicep size, calorie intake, wieght, body fat, and anything else we can measure.  I'm trying to be aware of it when those thoughts creep in and change them to healthier, more positive thoughts.  Second, I learned that I really need to be aware of my body and how I am feeling, both mentally and physically, and then respond to what it needs.  My body awareness is increasing as a result of this experience.  More important, my willingness to take care of my body (and mind), which includes resting and eating enough food, is increasing as I see how important these things are to my success and health.

Feeling Fear and Not Giving Up

Eight weeks prior to the competition, I participated in my first posing class.  The two-hour class, led by Joe Franco and his assistant, Lisa, was terrific.  Joe and Lisa provided the right balance of encouragement and constructive criticism.  The five other women in the class were friendly.  I learned A LOT about posing and how much I needed to practice to be ready for the figure show.

The class marked a turning point for me, though, in terms of the reality of what I had committed to do.  Up until that point, the competition seemed far away and sort of vague in my mind.  Participating in the class, however, made it much more concrete and imminent, and I understood for the first time how much of a novice I am at this whole venture.  The good news is that I didn't feel completely over my head.  I may have been the least proficient member of the class, but I kept up.  Still, it was intimidating.  Posing is a lot like ballet.  The experts make it look effortless, masking the years of practice it takes to gain mastery of the skill.  It isn't beyond my ability to pose well, but it will take months of daily practice, in addition to the rest of my training, to become even moderately good at it.

So I started feeling some fear and anxiety about the show.  What if I make a mistake on stage?  Fall off my shoes?  What if my body isn't developed enough?  Suppose the judges give me really low scores?  How will I feel if I come in dead last in both divisions in which I'm competing?

It took a day or two of thinking through these questions before I could make peace with my fears.  If I fall or otherwise make a mistake on  stage, I will just keep smiling and get back into position.  It would not be the first public mistake I've made on a stage.  (I have a history of singing, acting and public speaking.)  I reminded myself that this is just my first competition; I have more ahead in which to perfect my performance.  I also decided that my rank order in comparison to the other competitors is not as important as my actual score.  If my division includes fellow competitors who are all very well prepared, my score could be respectable for a beginner and still be the lowest in my group.  Beyond that, I remembered that I am doing this for some very important reasons besides my score.  I decided that, when competition day arrives and I walk onto the stage, I will remember that this is my victory walk over cancer, and that I am doing this to encourage and inspire everyone who faces a hardship and perseveres to reach a goal.  Finally, this is an act of worship for me, as I show my thanks to God for giving me such a healthy, beautiful body and for healing me of my cancer. 

Skin care, cancer treatment, tanning and competition

Cancer treatment is hard on your skin.  Chemotherapy, radiation therapy and estrogen suppression can each have an aging effect, and they seemed to cause my skin (especially my face) to look dryer and blotchier than before treatment.  Chances are likely that these problems had been creeping up on me over the past ten years (I'm 45), but I felt that cancer treatment was accelerating the process.  As a treat, I decided to visit and aesthetician for a facial and an at-home skin care program.  I've had a few treatments over the past six months, including light dermabrasion, laser treatment to remove a few spots, and a light (non-painful) acid peel.  These treatments improved my skin and I am planning to invest in a facial about twice a year.

I also purchased the (very expensive) Obagi skin care line of products.  They were great for my skin and people noticed a difference in my complexion.  Of all the products in the line, two are only available through a physician.  They are the tretinoin (retin-A) cream and the hydroquinone.  I quickly abandoned the hydroquinone, though, as there is controversy over its safety.  (Hydroquinone is banned in most of Europe, as it may be carcinogenic.  There seems to be debate over this claim, as it's legal in the U.S. through a physician.)  Tretinoin appears to be safe by everyone's standards and is effective in stimulating new skin cell production.  I've been pleased with the reduction of fine lines and evenness of my skin tone.  While the other products in the Obagi line (cleanser, toner, sunblock) were very nice, I decided that they were too expensive.  I've been buying cheaper cleanser, toner and sunblock and have been pleased with them.

My philosophy of skin care has always been pretty simple:  Don't smoke, don't tan, drink lots of water and get enough sleep.  I still do these things.  The one area in which I have improved, though, is sun protection for my whole body, especially my face, neck and chest.  I realized that the expensive products are rendered worthless if I don't maintain their effects by blocking the sun year-round.  My body and face moisturizers have an SPF of 15 or 30, and I wear them every day of the year.  If I am going to be outdoors for a lengthy period of time, I wear a stronger sunblock.  I have a growing collection of hats, and I seek out shade whenever possible.

One challenge of bodybuilding is that competitors must be very, very tan on stage.  This is to increase the look of muscle definition and to keep competitors from looking "washed out" on stage.  Many competitors will use tanning beds prior to competition, but this is not an option for me for several reasons.  First, I want to minimize my risk of skin cancer.  Second, I'm vain enough to want my skin to look young and healthy and minimize wrinkles as long as possible.  I've tried lots of sunless tanning products and use them on a regular basis.  My favorite brand is Fake Bake.  The spray looks good and is fast, but the mousse gives smoother coverage and lasts a lot longer.  Fake Bake won't be dark enough for a figure competition, though, so I'm planning to try Pro-Tan or Jan-Tana, two product lines specifically for bodybuilders.  My tan will have to be completely sunless, so I plan to experiment with Pro-Tan and/or Jan-Tana prior to the show to get the look right.

Body image, weight gain and competition training

I just posted a photo of Tracy Edwards standing next to my posing suit.  It's a beautiful suit and I can't wait to receive it in the mail and try it on!  Tracy and I have been trading email messages about preparing for the competition, and it sounds like she is also making plans to compete in a show (go, Tracy!!).  We were writing to each other about getting our bodies in shape, and our conversation prompted me to think about the way in which this process has altered my perceptions about women's bodies in general and my body in particular.  Some of it is good, but I'm not so sure about other parts...  Please comment on this post if you have something to share!

One of the harder things for me to do this spring was to consciously try to gain weight.  Bodybuilding is about developing muscles, which means they get bigger.  This means you get bigger.  In order to get bigger, you need to gain weight.  This was not easy for me, as I had spent my whole life trying to lose weight and stay thin.  I went on my first diet when I was about 13, and I have worked at maintaining my slender figure my whole life since then.  I had never tried to gain weight until now.

It started six months ago, when Domenick (my trainer) developed my first fitness program specific for muscle growth and suggested that I add calories and protein to my diet.  I didn't gain weight by eating snacks and sweets.  I added to my diet a whole protein supplement, more servings of lean fish and chicken and more complex carbohydrates (i.e. oatmeal, sweet potatoes, apples, whole wheat tortillas).  I also watched the scale climb from 144 lbs. in January to 152 lbs. by June.  Yikes!  It was good weight gain, though, and my muscles were visibly and measurably larger.  I had to keep reminding myself of this.  In hindsight, it would have been good to gain even more weight, and I might feel braver to do that when I train for my next competition. 

I had feared that gaining weight would mean my clothes would become tighter, especially in the waist.  This was a particular concern for me because whenever I gain a couple of fat pounds, it all goes to my abdomen and people think I am pregnant.  (This has happened on more than one occasion and is very demoralizing.)  What pleased me with the weight gain this spring was that my clothes continued to fit me well, and my waistline didn't change.  I will confess that my sleeves became tighter due to larger muscles in my arms, but I didn't mind this too much.  I was feeling proud of my biceps.

What is interesting to me is that I now find more muscular women to be beautiful.  The "skinny is the only way to be beautiful" fashion-model mindset has lost some of it's grip on me, and I now find myself thinking that the typical fashion model would be better looking if she gained a little muscle weight.  When I first decided to train for a figure show, the muscularity of the women was still a little unappealing to me, but this has changed remarkably over time.  The look has great appeal to me and I take pleasure in watching my physique develop.

A trend I am seeing in myself that is not so good is the difficulty I have in believing that my body does, in fact, look trained and attractively muscular.  Much like the anorexic, I look in the mirror and don't see what other people see.  I will think "I don't look like much", when even strangers will comment on how developed and strong my legs look.  Getting comments like this from people I have just met is a reminder to me that I am not seeing my body objectively.  Maybe none of us do.  I would like this to change, though, and I am beginning to stop myself in the middle of the self-critical thoughts and remind myself of what is true.

Estrogen, sleep, hot flashes and training

My breast cancer was "estrogen-positive", which means that the presence of estrogen in my body made the cancer grow.  To combat this, I began taking the drug Tamoxifan after I was diagnosed.  Tamoxifan suppresses estrogen production, and I stopped having menstrual periods in June 2009, after a month of taking the drug.  I'll take Tamoxifan for at least five years.  In December 2009, I had a total hysterectomy which included the removal of my ovaries.  This reduced my body's estrogen production even more and officially put me into menopause. 

A low estrogen level leads to some unpleasant side effects, as many menopausal women will tell you, whether they've had cancer or not.  It increases your propensity toward a gain in body fat and loss of lean mass.  It also causes hot flashes, which lead to difficulty sleeping at night. 

I go to sleep about 10pm and, on a good night, I won't wake up until 4 am.  I may or may not be able to go back to sleep, and will usually get up before 6 am.  Being tired can make training more difficult.  To ensure that I get enough rest to make training possible, I stay in bed even if I wake up in the middle of the night. I resist the urge to get up and will practice deep breathing and meditating to help me relax and rest, even if I can't sleep again.  I think this helps me have more energy during the day.  Even if I am tired, I still work out and find that, once I get started, I'll have a bit more energy than I thought I would.  On days that I don't feel that energy, my workouts are not as strenuous and I simply accept it, knowing I did the best I could.

In hot weather, I find that I need to work out early in the morning because it's cooler.  I'll have hot flashes when I exercise, which can be pretty uncomfortable.  Exercising in front of a fan helps, as does exercising indoors and keeping the air conditioning at a lower setting.  I can't take any hormones or herbal supplements that raise my estrogen level, but I have had accupuncture treatments which I think have reduced the number and severity of hot flashes I've experienced.

Something I have been very pleased with is the fact that I have been able to build muscle mass despite a lower estrogen level.  Having lower estrogen makes it harder to build and maintain muscle, but it's not impossible.  I want to encourage other post-menopausal women to not lose hope if they are struggling to build muscle and lose excess body fat.  I've also adjusted my diet to be lower in fat and higher in lean protein, which helps keep my body fat lower and lean mass higher.  I will write about this separately in another blog, but I wanted to mention it here. 

Training After Surgery

Since my cancer diagnosis in March 2009, I have had four surgeries.  They include the double mastectomy, additional lymph node biopsy (both sides), a hysterectomy (open, not laparascopic) and  a final surgery to replace the tissue expanders in my chest with silicone implants.  The two hardest surgeries were the double mastectomy and hysterectomy; I experienced the most pain and limitations after these.  After the first three surgeries, I had one or more surgical drains in place and was advised by my surgeons to not lift anything heavy or engage in exercise beyond walking for six weeks.  My final surgery was simpler, and I was limited in my lifting and exercising for just 3 weeks.

I was very careful to follow my surgeon's directions after each surgery.  I did not lift heavy objects, run, or engage in any upper body weight training until I reached the 3 or 6 week mark.  I was committed to healing properly and not causing any damage to sites where I had surgery.  With that said, I was intentional about not being sedentary during this time of healing, as I knew that would not be good for my health or fitness goals.

The day after each of the first three surgeries, I got up out of bed and moved around the hospital room.  I was careful to sit down if I felt dizzy or in pain, but when I felt good, I would stand up again.  The day after the mastectomy and lymph node biopsy, I began a daily routine of "walking my fingers up the wall" to maintain my arm and shoulder range of motion.  This was critical to do as soon as possible.  Had I waited longer, it would have become much more difficult and painful to lift my arms.  (My fourth surgery was as an outpatient, and I was standing up an hour after I was awake in the recovery room.)

Each day after surgery, I would do a little more standing and walking in my house.  By the third or fourth day, I ventured outside and walked slowly up and down my street.  It was hard to do this with surgical drains in place, but it worked as long as I had the drains wrapped snugly against my body.  I also added in more stretching each day, progressing to a full-body stretching routine.  At one week post-surgery, I could walk a slow mile and then stretch.  During the second week post-surgery, I would take this one-mile walk twice each day.  Gradually, the walks became longer than one mile.  I also started adding some simple muscle toning exercises while at home.  I did calf raises and standing leg lifts while balancing myself against the wall.  Finally, I sat on a stability ball instead of a chair beginning the second week post-surgery.  While I did nothing more than sit on it at first, this helped me utilize my core muscles in a gentle way.  I then added some simple lower-body exercises while sitting on the ball.  I was very careful to maintain my balance and didn't do any movement that could have caused me to fall off the ball.

I was able to walk a mile because my pre-surgery fitness level was very high.  Someone who is less fit going into surgery should not try to walk, move and stretch as much as I did or as quickly as I was able to do it.  I never pushed myself; if I felt pain, fatigue or discomfort, I stopped and rested.  The walking and stretching felt great.  I think I needed less pain medication and slept better at night because of it.  I also know it helped me feel more optimistic and peaceful.  (Anyone who exercises on a regular basis knows its power to improve one's mental health.)

By the time I reached the 3 or 6 week date post surgery, I was feeling strong, flexible and ready to train again.  Each time, I took a week to build back up to my pre-surgery level of training, but it was not difficult to do this.  I'm convinced that the walking, moving and stretching I did during the six-week recovery period made the difference.  (I was also careful to eat well and include enough protein, water and complex carbohydrates.)

Because I wasn't completely sedentary and ate a nutrient-dense diet during the recovery period post-surgery, I lost little muscle mass and physical ability during those times.  This was very encouraging, as I was concerned that I would lose the fitness gains I had made prior to each surgery.  My fears that I would lose muscle and increase body fat weren't realized during any of these periods.

Feeling sad and training anyway

Through most of my cancer treatment, I did not feel much sadness or depression.  It's not that I was ashamed of those feelings or thought I shouldn't have them, but I knew I needed all of my energy to keep moving through surgery and treatment.  It seemed as if my feelings were a luxury I couldn't afford at the time.  If I let myself get down, it would have been really hard to go back for the next chemo treatment or have the next surgery.  I knew that, at the end of treatment, those feelings might come and it would be time to face and accept them.

My tendency in life is to be optimistic.  I usually see my glass as being half full, and finding the good in difficult situations is not hard for me to do.  This ability helped me remain hopeful through treatment and not give up on my goals, including the figure competition.  Through my treatment, I met several women who were also facing breast cancer, and it was interesting to hear their responses.  A number of them struggled with depression and hopelessness during and after treatment.  It was not uncommon to hear another woman tell me that she stopped exercising, socializing and otherwise taking care of herself during treatment.  I was just the opposite and felt very motivated to take even better care of myself than I had been doing.  I found that I could do this without feeling guilty of being self-centered, which I would have felt pre-cancer. 

After my third surgery, a hysterectomy, I felt that I had come to the end of my treatment and that the hardest part was behind me.  I still had reconstructive surgery to complete in six months, but that would be a smaller surgery and was not part of cancer treatment.  Psychologically, I reached the point where I knew it was time to feel my feelings, and I did. 

What I felt (and can still feel at times) was more like a sadness than a depression.  I'm not sure what the difference is, but it seems like there is one.  I am fortunate that the feeling has never lasted more than one day.  I felt this sadness one to three days a week during the time after my hysterectomy and before I went back to work full time (about 5 weeks later).  My job, which I enjoy, was very busy and I found myself once again putting the feelings of sadness on hold.  Now that the semester has ended (I am a college professor), I'm finding that my sad days are returning periodically. 

My primary way of handling the sad feelings is to acknowledge them, but to keep moving through the day as best I can.  I may not have the energy to train as hard as I normally would, but if I can just make myself start, I will finish the workout.  I do this with my other activities, too.  I'll stop and take short rests, but then get going again with as much as I can do. 

Friends have asked me if I would consider joining a support group or get counseling therapy.  While I'm not completely opposed to a support group, I am hesitant to join one.  My fear is that the other women will be depressed and bring me down.  I'm also not sure that I will find other women in my stage of life and at my activity level in the group.  We might not have as much in common.  I am more open to getting counseling therapy, as I've had it in the past and liked it.  Right now, I don't want one more thing on my schedule, which is probably another way of saying that I don't feel such a strong need for it.  This could change. 

One thing that has been very meaningful and helpful is to have people help me spiritually.  I have been meeting with Ruth Workman for years for spiritual formation.  Ruth and I meet once a month to talk about my life and where I experience God at work in all that is happening.  I needed to take a break from our meetings during treatment, as I didn't have the emotional energy for them, but it is good to be meeting with Ruth again.  I had another wonderful experience right after my initial diagnosis and surgery with a Stephen's Minister from the Woodside Presbyterian Church.  Sara Ewing and I spent several times together as she prayed for me and my family.  Sara was a caring, empathic listener and I am really grateful for the time we spent together.  This summer, I am finding that I am able to meditate on scripture and pray again, and I do that each morning with my husband, Stuart.  I know that God is holding me in his hands on the sad days.

Oh, one more thought.  I find on my sad days that it is nice and cathartic to watch a movie or listen to a song that lets me feel sad.  Today is one of my blue days, and I've listened to Howard Jones' No One Is To Blame about five times already.  It helps to just tune out with a good, sad song and let the feelings out.

My diet and training during chemotherapy

I trained and monitored my diet through 18 weeks of chemotherapy, and I think it made a tremendous difference in keeping me feeling good and functional as much as possible.  I would encourage anyone going through chemotherapy, whether they want to engage in body building or not, to exercise regularly and to eat carefully.

Here are a few things I did:

Exercise during Chemotherapy

My chemo treatments were tough.  Many women with breast cancer will have 8 treatments and alternate between drugs.  I had six treatments, but I received all three standard drugs (TAC) at every treatment.  My treatments were three weeks apart (instead of two) for this reason.  It would take until day 11 post-treatment for me to feel healthy again, so I would have a little more than a week of feeling strong before the next treatment began. 

I would have treatments on Monday afternoons for 4 1/2 hours.  My worst day would be Thursday, so I had a massage on that day from either of two massage therapists who were trained to work with cancer patients.  Donna and Brenda were the two therapists at St. Mary's Hospital Wellness Center (in Langhorne, PA) and they were wonderful.  The massage on my worst day helped me get through it more easily.

Each day without exception, I would make myself get out of bed, get dressed and take at least one slow walk in my neighborhood.  It was hard to get out of bed, but once I was out, I would start to feel better.  I would also do a 20-minute stretching routine each day.  As the days went by, I could walk and stretch a little more until I reached the 8th day, when I would add in some resistance training.  By day 14, I could jog 2 miles and do a fairly intense resistance training workout, which I would do each day for the week prior to my next treatment.  I am convinced that this made me stronger for the next chemo treatment, and I my chemo symptoms were reduced because of my training. 

Every Monday morning, my trainer (Domenick Salvatore), would come to my house and work with me.  Even if it was day 8 and I couldn't do much, he came anyway and I did as much as I was able.  Psychologically, this was very important to me.  It helped me feel less like a cancer patient and more like a healthy athlete.  How I perceived myself was cricital to my ability to stay active.

The great thing about training all through chemo is that I was able to maintain my fitness level so that, at the end of cancer treatment, I was still in good physical condition and ready to prepare for body building.

Diet during Chemotherapy

I experimented with my diet after each cycle and, by cycle 3, had figured out the best eating plan to help me feel better and move through the symptoms faster.  Don't get me wrong; I still felt lousy much of the time, but not as bad as I could have felt.  Many people lose weight during chemotherapy, but others gain weight because they are not exercising and they find that constantly eating can help settle their stomachs.  My goal was to maintain my weight throughout chemo.  I tried to limit the sweets and high-fat foods, and to eat as much organic, whole food as I could. 

During the first few days of chemo, I would get up at 2 a.m. or so (I would naturally wake up) and go into the kitchen for a small bowl of shredded wheat 'n bran cereal with skim milk and two 12-ounce glasses of water.  I didn't always want the water, but putting lots of ice in it and drinking it slowly helped get it down.  This middle of the night snack helped me feel less queasy in the morning.  Hydration during the first few days was also important to get the chemo drugs out of my body faster and help me feel better.

As much as possible, I limited sodium in my diet, as it only made me feel worse.  I ate small, frequent meals with minimal spices, sugar or fat in them.  Too much fat or oil in a food would make me feel worse after eating it.  I also gave up ginger ale after my first cycle, as the sugar did not leave me feeling so good.  Diet ginger ale tasted bad during this time, as chemo changes your sense of taste.

Eating healthfully and exercising gave me not only physical improvements, but psychological ones as well.  It felt good to be taking care of myself during this time and doing all I could to minimize the negative effects of chemotherapy.

How I manage to weight train with lymphedema

Through the late 1990s, women who had breast cancer surgery (especially lymph node removal) were told to not lift anything over 15 pounds…. ever. Lymph nodes in the armpit area are removed and tested to see if the cancer has spread beyond the breast. It’s an essential biopsy to have, but one with lifelong implications. Lymph nodes are necessary to keep the body’s lymphatic fluid circulating. When lymph nodes are removed, it can make the circulation of this fluid more difficult. Women can experience lymphedema, which is a swelling of the arm with lymph fluid. Lymphedema is a chronic condition; you may be able to prevent it from getting worse if you are careful, but it is not likely to go away. Several things can trigger lymphedema, including lifting something heavy (without taking precautions ahead of time), excessive heat (from, say, sitting in a hot tub or sauna), and the cabin pressure change in an airplane.


I had approximately 12 lymph nodes removed from both armpit areas, since I had cancer in both breasts. About four months after my surgery, I was doing some moderate resistance training with exercise bands, when my right arm began to swell suddenly. I knew about lymphedema and recognized what was happening to me. Still, I felt slightly panicked and dismayed. I had been gradually building up my level of resistance training and hoped that I was fit enough to avoid this chronic problem. (Being fit is not insurance against lymphedema, though.) I quickly raised my arm in the air and began massaging it, and the swelling started to decrease, although it has never gone away entirely.

I had been receiving physical therapy to increase the range of motion in my right arm and was working with two terrific therapists, Linda and Melissa of Hamilton Physical Therapy Services (HPTS) in Hamilton, NJ. Both are cancer survivors themselves and trained to work with women who have had breast cancer surgery. In addition to the therapy they gave me in their office, they helped me do two very important things.

First, I was fitted for and ordered a pair of lymphedema sleeves. I wear these stretchy lycra-blend sleeves, which cover me from my hands to my shoulders, every single time I exercise. This includes any type of exercise, whether I am “working” my arms or not. I wear the sleeves when I run, use the elliptical trainer, work my core muscles, or even go for a brisk walk. If my heart rate is elevated, the sleeves are on. If I forget to put on the sleeves (which never happens anymore) and I begin to exercise, I will feel my right arm start to swell. My health insurance paid for these $196 sleeves and will cover a new pair every six months, which is the standard replacement time. I also wear the sleeves when I fly in an airplane.

Second, they taught me how to do Manual Lymphatic Drain (MLD) massage on myself. It takes about 2 minutes to go through the whole technique, is relaxing and feels good. I am also convinced that by doing it daily for 5 months, I was able to reduce the swelling in my right arm further. I will confess that I no longer do the complete technique due to the time it takes, but I do a modified version of it throughout the day. I’ll do it in the car (holding the steering wheel with my right hand and gently massaging the arm with my left hand – not dangerous, I promise!) and throughout the day when I have a few moments where I am not active. My colleagues and students have become used to having me do it in meetings. I even do it in my Sunday School class at church when I’m not teaching.

This was an area where, in a healthy way, I felt the challenge to buck tradition and not accept the limitation of never lifting anything heavy again. Having lymphedema is another challenge to overcome, and I feel stronger for being able to weight train and bodybuild despite the condition. I was also very encouraged to come across the work of Dr. Kathryn Schmitz, an epidemiologist and exercise physiologist at the University of Pennsylvania.  Dr. Schmitz has studied the effects of weight training and lymphedema among breast cancer survivors, with some very encouraging results.  Here's a link to a great NYTimes article about her work:

http://www.cceb.upenn.edu/news/swelling.pdf

So, to summarize, I train six days a week and have gradually worked my way up to using a heavy amount of resistance.  That I did it gradually is key; increasing the resistance too quickly would have exacerbated my lymphedema.  I wear my sleeves EVERY time I exercise and I keep them on through the stretch and cool down.  I follow this with MLD massage on my arm.  This system has been working very well for me.

Why and when did I decide to enter a body building contest?

Prior to my cancer diagnosis, I had been feeling the some of the burden of middle age.  It felt like my life was built on all of my RESPONSIBILITIES.  I was a wife, mother, home-maker, professional, and the spouse of a pastor. These are all wonderful things, but they all involve commitment and effort.  They also felt pretty predictable.  I was ready to have a new challenge; something personal, youthful and that would take people by surprise a bit. While I was very fit and healthy, most people would not have expected me to pose on stage in a glitter bikini and four-inch heels. It felt fun to take a risk and do something unpredictable.

At the start, I was pretty sure that I had the build and self-discipline to train for a body building competition.  Working out with Domenick and John every Monday and Wednesday was also very motivating.  I mentioned the idea to them one day and they were both immediate and sincere in telling me that they thought I had the potential to do it if I wanted to.

In early March (just before my cancer diagnosis), I was still debating whether or not to set this goal for myself.  After receiving my diagnosis, something changed for me and I knew I wanted to train and compete as a body builder.  Why?

First, it was something positive to look forward to and work toward during my cancer treatment.  Over 13 months, I had 4 surgeries (the last one will happen next week, June 4, 2010), 18 weeks of chemotherapy and 6 weeks of radiation.  It is a test of endurance, like running a marathon.  Often when I was feeling tired and sick, I would read about body building and imagine how great it would feel to walk across a stage in a beautiful, healthy, fit body.  My good friend and former student, Jason Kilderry, is a triathlete with an amazing story of his own.  After losing both kidneys and receiving a kidney transplant, Jason is preparing to hike the Appalachian Trail.  He was an inspiration to me as I faced my trial.  He says that thinking about and planning for his Trail hike kept him going through his low points during dialysis and surgery.  I understand that exactly, now.

Second, it is a symbol of my victory over cancer.  I've noticed that cancer has a way of aging people, both mentally and physically.  They can become less active, enjoy fewer things in life and seem to age more quickly.  A year of cancer treatment can appear to make a person seem five years older, from what I have observed.  I took it on as a personal challenge to not let this happen to me.  I was determined to remain active, to workout on a daily basis, eat very healthful foods,  take care of myself and enjoy my life through cancer treatment and beyond.  The idea of emerging from over a year of cancer treatment and entering a body building competition   was the perfect challenge for me.

What was it like to find out I had breast cancer?

In January 2009, I had my yearly mammogram as usual.  I had never had any problems before or needed a repeat mammogram.  Wait... when I was 28 years old, I felt a small lump in my left breast and had it removed.  It was benign.  Otherwise, there had been no problems with my breasts.

About 3 weeks after my mammogram, I was called in to have additional mammography done on my left breast due to some tiny calcifications that showed up on the first films.  I wasn't worried.  This happens to a lot of women.

But after the second set of films were taken, I got a phone call from my gynecologist that caught more of my attention.  He did not sound worried, but he was emphatic that I needed to have a biopsy in my left breast AS SOON AS POSSIBLE.  Wow.  Still, there was no history of breast cancer in my family and I was (and still am, in my opinion) a very healthy person.

The biopsy of my left breast was an odd experience.  I've had biopsies and minor surgeries before, where I was given a sedative, made numb in the area, and had the necessary tissue removed.  This was different.  I had to lay face down on a table that had a hole in it for my left breast to hang through.  (I wasn't that big, so it didn't hang down very far!)  My breast was then squeezed between two mammography plates and x-rayed so the surgeon could identify the spots where tissue needed to be removed.  He was under the table and inserted a device into my numb breast to extract the tissue sample.  I remember that it made a loud popping noise (like an air gun) when he inserted it into my breast.  It was quick and relatively pain-free, but unnerving.

I remember the moment I found out I had cancer.  I was sitting in my office (at Rowan University in NJ).  It was 4:50 and I was just about to walk down the hall to the fitness lab in my department, where I would meet with two students who were training me as part of their Practicum project.  Domenick Salvatore and John Stevenson were great students and trainers, and we were having a lot of fun every Monday and Wednesday at 5pm, despite the fact that I was working out really hard!  I noticed the message light on my phone; my surgeon had called, requesting that I call him back.  I reached his assistant, who told me that he had gone for the day and would be unavailable the following day.  I was going to have to wait until Friday to find out the results.  She thought for a moment and said "You seem like the kind of person who would want to know right away, so I'll tell you.  You have breast cancer."  Well, she was right.  I am the kind of person who wanted to know right away and I thanked her for telling me.  The conversation was over in 10 minutes.

It was 5pm; time for my workout.  For about 30 seconds, I wondered what I should do.  Should I call my husband?:  My mother?  I decided that what I really needed to do was to work out hard, and that I would rather tell my husband in person and let my mother get a good night's sleep before I told her the news that was sure to cause her a lot of pain.  So I went to my workout with Domenick and John.  Although I was distracted mentally, I just wanted to tune out and push my body as hard as I could, which is what I did.