Before You Begin

Thriving After Breast Cancer: Essential Healing Exercises for Body and Mind
by Sherry Lebed Davis, Stephanie Gunning

A breakthrough book for America's 2.5 million breast cancer survivors, showcasing the pioneering "Focus on Healing" exercise-and-movement program touted by physicians coast-to-coast and recommended by the American Cancer Society.

The months following breast cancer treatment can bring a difficult combination of emotional and physical challenges, including a decreased range of motion, pain, fatigue, and depression. But when Sherry Lebed Davis's mother was diagnosed with breast cancer in 1979, Davis and her two brothers, both physicians, created a special movement therapy program to speed their mother's healing. Spurring extraordinary success in her and many others, "Focus on Healing" soon became on of the first hospital-endorsed dance and exercise programs in the nation, a prescription that Davis came to appreciate even more when she herself became a breast-cancer survivor in 1996.

Taking a unique, proven approach to healing, Thriving After Breast Cancer shares the easy-to-follow techniques that have improved the lives of thousands of patients. Embracing psychological recovery and treatment of chronic pain, Davis's "Focus on Healing" regimen consists of stretches and dance-inspired moves that restore flexibility and balance while minimizing discomfort. With exercises to address a full range of specific situations, whether the reader has experienced chemotherapy, a lumpectomy, of a full masectomy, Thriving After Breast Cancer offers solutions that can be gently eased into a patient's routine. Now adopted by more than one hundred hospitals around the country (including New York City's prestigious Memorial Sloan-Kettering) and picking up where medical treatment leaves off, Davis's program gives breast cancer survivors an uplifting, empowering next step on the road to restoring the life that they life.

Chapter 1

By choosing this program you are honoring the needs of your body and making a commitment to the quality of your life. You have chosen to thrive. I salute you and I support you. I want you to have the safest and most pleasurable experience possible when you participate in the Focus on Healing exercise program.

As breast cancer survivors, we have unique needs and concerns. Some of these are physical and some are emotional. But none are a reason to avoid exercise. In fact, regular exercise can help with everything you feel and do. It can make you stronger and more flexible. It can relieve tension, elevate your mood, and give you a chance to celebrate and express your femininity. However, you must take your individual needs into consideration and exercise with care.

Your physiology has been changed by the type and extent of the surgery you have undergone. Lumpectomy, mastectomy, node dissection, and reconstruction all leave permanent imprints. Furthermore, your body may also be processing the radiation or chemotherapy that you received to treat your cancer. Perhaps it has been years since your surgery and you've been relatively inactive, or you are at risk for lymphedema - swelling that results from blockage in the lymphatic vessels - or have other health concerns. For these reasons it may be important to have a conversation with your doctor before you begin this or any other exercise program.

If you are a recent survivor, you may begin doing the Focus on Healing exercises as soon as your surgical drain is removed with the approval of your doctor. The surgical drain is a tube the size of a drinking straw that's inserted into your side a few inches below the armpit to siphon off excess lymphatic fluid. It has a bulb on the bottom. Sometimes you get two of them, the second being placed in the chest wall. A drain is kept in the body anywhere from three days to a week on average, until your body makes an adjustment.

Many surgeons have their patients begin doing simple arm movements during early recovery. These are extremely gentle and safe, as are the Focus on Healing exercises. Still, I recommend waiting until the drain is removed so that no unexpected complications occur at the site of your drain incision. It is a sensitive time and it is critical that you give your body the time to heal properly.

ABOUT THE PROGRAM Focus on Healing was designed under the supervision of two gynecological surgeons, Marc Lebed, M.D., and Joel Lebed, D.O. Dr. Marc Lebed is currently the medical director of the program and ensures that it incorporates new advancements in medicine. The exercises are based on kinesiology (the science of movement), anatomy, and gentle ballet and jazz dance movements. Focus on Healing uses progressive patterns of passive and active arm movements to facilitate and improve your postoperative range of motion. It has been shown that these activities can also diminish your risk and incidence of lymphedema. In addition, lower-body exercises target muscles that enhance your posture and balance. The experience of doing the program is enjoyable and even sensual since it combines movement therapy with dance.

Focus on Healing works many important areas in your neck, shoulders, back, chest, torso, arms, hands, and fingers. The illustrations opposite identify the names of the muscles that are being used and receive benefits.

What kind of exercise should I do and what kind should I avoid? And when is the appropriate time for me to start exercising? Factors from your medical history that your physician will take into consideration include whether you are a recent or long-term survivor; whether you are currently undergoing chemo- or radiation therapy, your age, general health, and fitness; and whether you are a regular exerciser.

How high can I lift my arm? And when? Your range of motion dictates the nature of the activities in which you can participate. Full range of motion means that you can lift your arm all the way up and slightly behind your ear while holding it close to your head. You can restore your flexibility through regular stretching, even when you have the extreme condition known as frozen shoulder. As I will repeat throughout the book, you should never do a movement that causes you pain. In a few pages I will help you assess what this means.

What is my weight restriction? How much weight can I lift with my surgical arm? And when? During recovery from surgery you lose strength and muscle tone and gain scar tissue. Radiation also tends to shorten the strands of the muscles. To exercise safely, you must know your limitations. You do not want to tear scar tissue while you are in the process of rebuilding your strength and flexibility.

What is my risk of lymphedema? Anyone who has had a lumpectomy, a simple mastectomy, a modified radical mastectomy, or axillary node dissection (the surgical removal of lymph nodes from the armpit), often combined with radiation, may be at risk for lymphedema. These treatments can reduce the functioning of your lymph nodes. Lymphedema can involve swelling of your breast/chest, arm, hand, and fingers and is caused by lymphatic fluid from your immune system pooling in these places. The swelling can result in discomfort. You can develop lymphedema at any time after surgery, from immediately to a couple of months afterward, or even twenty years or more down the road.

Copyright © 2002 by Sherry Lebed Davis with Stephanie Gunning.

About the Author

Sherry Lebed Davis became a professional dancer at the age of fifteen. She now devotes her time to spreading the word about "Focus on Healing," lecturing and leading classes at hospitals around the country. Her work has garnered wide media attention, including "Weekend Today" and People magazine. She lives with her husband in Seattle, Washington.