Yoga for Cancer: An Interview with a Nurse and Cancer Survivor

Butterfly by Melina Meza

Two of our readers, Susan Reeves and Pam Ryan, are co-founders and teachers at Yoga Bridge - Yoga for Cancer in Denton, Texas. When they offered to interview one of their students for the blog about her personal experience practicing yoga as a cancer survivor, we jumped at the chance. The student they chose to interview was Judie Craven, RN, who, as both a nurse and a breast cancer survivor, has a special perspective. —Nina 

Susan/Pam: Why don't you start by telling us a bit about yourself, Judie.  

Judie: I've worked in the medical field for over 23 years in all clinical aspects of nursing: oncology nurse, physician's nurse, medical nurse, radiation nurse, and now as a practice administrator. I also work to promote awareness and raise funds for breast cancer research and patient support with other organizations in my community.

In the fall of 2009 I was diagnosed with early stage breast cancer, which was found on a routine mammogram. I recall sitting in my car in the parking lot of my doctor’s office when I got the call that my biopsy was positive. Here I was, three months after the traumatic end of my 30-year marriage, alone and hearing that I had breast cancer. It was surreal. I thought, “God, why me?” Then I realized that I thought I knew what it was like to hear those words (by that time I had treated thousands of cancer patients at my facility), but my understanding pre-diagnosis wasn’t even close to this new reality.

Susan/Pam: So why did you start practicing yoga and how have you found it personally helpful?

Judie: I started with the Yoga Bridge group in 2012. I decided to attend the class because I thought to myself, "These nice ladies are donating their time. I am a cancer survivor so I should go to set a good example for my patients and staff." Little did I realize how this program would enrich my life! I was immediately embraced by a group of compassionate, understanding friends who knew exactly how I felt and we quickly became a source of support for each other, forming sincere and supportive friendships. Even surrounded by your own family and friends, cancer is a lonely disease that can leave you feeling that you have failed and/or that your body has failed you. To be among your peers is comforting beyond description. 

Susan/Pam: How about the yoga asanas—do you have a favorite pose that you've found particularly helpful?

Judie: Downward-Facing Dog. My job can be pretty stressful! Down Dog helps to release tension better than any other pose for me. It stretches my whole body and makes me feel strong—like I can accomplish anything.

Susan/Pam: That pose is a great choice for someone who has returned to full health after a diagnosis. So, have there been any challenges in your yoga practice because of your cancer diagnosis or treatment?

Judie: One issue I had was scar tissue at my surgery site—I had some limitations with movement there. My teachers at Yoga Bridge taught me specific movements and stretches that  helped improve my range of motion. I previously tried yoga classes at my gym, but Yoga Bridge offers smaller classes and assistant teachers who are knowledgeable enough to help students customize postures to their specific needs. That way, everyone has a successful practice.

Susan/Pam: In general, why do you think yoga is such a good fit for someone with cancer?

Judie: One of the most important things a cancer patient can do is learn to manage their energy levels. For many, the diagnosis and treatments can cause extreme levels of fatigue. In general, exercise can greatly help to manage that. What sets yoga apart is that you can go at your own pace and choose from a seemingly never-ending list of exercises for the mind and body. Once you’re taught how to modify, you can adapt according to your own level of energy in almost any class,. Yoga is a good overall fitness plan for both those who need something gentle and also for those who are ready to rebuild strength and balance.

I've also noticed how yoga helps with my own stress levels. It makes me feel grounded and centered, and I sleep better. It works for many of my patients, too. Linda has been in and out of treatment for metastatic breast cancer for almost nine years. She says yoga gives her “me” time to meditate and relax through rhythmic breathing, stretching, smooth flowing poses and Savasana, which let her body rest and be in a calm state for 75 minutes. Away from the family, appointments, errands, the endless to-do list, intrusive stressful and often depressive thoughts, she finally can be one with the space she is in. It can be a very spiritual experience.

The breathing exercises are tools we can use to calm or energize ourselves inside and outside of class, especially simple techniques like even count breath or mental alternate nostril breath. It’s usually the first thing new students latch onto. They come to class and tell how they were able to make it through scans, lab visits, and infusions with remarkably greater ease. These are easy exercises to remember and can be done anywhere at any time. Combining breath with wonderful guided imagery meditations is a special treat. Over the last three years I have been able to observe my progress by recognizing I am better able to quiet my normally very busy mind. Amazing.

I also love Nadi Shodhana at the beginning of hatha class. At first I was a little anxious when retaining my breath, but my stamina increased, as did my overall energy level. It’s so invigorating!

Personally I enjoy both hatha and restorative classes; however, restorative yoga is particularly appropriate for patients as they go through chemo and radiation. It's so gentle and accessible. It allows a person to be still and quiet the anxious mind while stretching and supporting the tender in-treatment body. 

Susan/Pam: As yoga teachers, we’ve noticed that, at first, many of our students are afraid to practice yoga—they don't think they are flexible enough, physically strong enough...many reasons. What would you tell someone with a recent cancer diagnosis about Yoga for Cancer classes?

Judie: I think that most people have not been exposed to this type of yoga. My own first experience was in a local health club and, although I consider myself to be physically fit, I was completely lost! It seemed everyone around me already knew what to do and I was so intimidated. But with smaller classes and specially trained teachers, I’ve learned how and when to modify poses, and I know that yoga can accommodate anyone, no matter their fitness level, with or without a cancer diagnosis. It's important to find the right teacher who knows specifically how cancer diagnosis and treatment changes the mind and body. I recommend looking for teachers who have had specialized training in yoga for cancer and restorative yoga, as well as someone who focuses on breathing exercises and meditation. Smaller classes are crucial, too. 

Susan/Pam: For yoga teachers out there, can you tell us how to approach the medical community about teaching a class for their patients?

 Judie: You need to impress upon the medical community that yoga designed specifically for the cancer patient is safe. Focus on all the benefits it provides: stress reduction, community, strength, and confidence. Explain how it is taught with modifications to the standard poses to fit the individual. 

Susan/Pam: Judie, thank you so much for sharing your story. You are such a positive force and we especially appreciate your candor. It is our hope that your words will inspire people with cancer to reach out and find the yoga community that is ready and willing to support them.  

Susan Reeves and Pamela Ryan are E-RYT yoga teachers and co-founders of Yoga Bridge. Yoga Bridge is a 501(c)(3) nonprofit that provides evidence-based coping strategies to complement medical treatment for cancer and recovery. They offer free and low-cost yoga programs to all people affected by cancer. Students are part of a nurturing community where they find relief from fatigue, muscle weakness, and stress. Yoga Bridge also offers teacher trainings in yoga for cancer twice a year. Email yogabridge@hotmail.com for more information.

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Yoga for Cancer: An Interview with Cheryl Fenner Brown

by Nina

Cheryl Fenner Brown by Melina Meza

It's a bit dangerous when I actually leave the house and attend a yoga event of some sort. Inevitably I start talking with a yoga teacher who is doing something really interesting, and I start pitching the idea of a guest post or interview on their area of expertise for the blog. Yep, I'm like that—relentless. Recently, I recently ran into a old yoga friend, Cheryl Fenner Brown, who I hadn't seen in several years—we used to practice teaching each other back in the days when we were training to be teachers—and found out about the wonderful work she's doing on yoga for cancer. As usual I made my pitch, and here's the result.

Nina: Tell us a little about yourself and how you got started teaching students with cancer.

Cheryl: I came to yoga in 2001 as a stressed out software trainer and gym junkie. After sitting at a computer all day I would rush to the gym and jump on the cardio machines with a book in my hand, music in my headphones, and usually a TV going somewhere nearby. Multitasking was so ingrained in my workday that it infused my workouts as well. The first time I took yoga and was asked to do one posture and breathe, it opened up my eyes to the freedom within slowing down and focusing on one thing. It wasn’t long until I dreamed of blending my work in teaching adults with my new-found love for the yoga practice, and in 2004 I started the Advanced Studies Program at Piedmont Yoga Studio.

After the 18-month program I still had so many questions, especially about how certain types of postures affect our emotions and energy. I was always asking, “Why do backbends make us feel happy and forward bends create calm?” I soon realized that more training was in store, and I enrolled in the Integrative Yoga Therapy’s Professional Yoga Therapists program first at Mt. Madonna and then at Kripalu in Massachusetts in 2007. The following year I was approached by Piedmont Yoga Studio to begin teaching a class for cancer patients, and the Living with Cancer program began with financial sponsorship by the Piedmont Yoga Community, a 501c3 organization that brings yoga to people with challenges. I continued to give classes at several other area yoga studios but I realized that I needed to connect with a cancer support group who could direct students into the classes. Then, in 2011 a student connected me with the Cancer Support Community of Walnut Creek, and I now teach two weekly classes and a monthly Yoga Nidra class at their location.

As I have continued to teach students with cancer and learned about how deeply this disease affects both my students themselves and their families, I have been humbled by the strength and perseverance I see on a daily basis. Also, I became a satellite caregiver to my father after he was diagnosed with cancer in 2010 and have now lost many friends and students to the disease over the years. I am honored to be able to show these people simple ways in which they can gain back some peace and comfort as they go through this life-changing process. It is truly empowering to witness.

Nina: Why do you think yoga particularly helpful for people with this disease?

Cheryl: When someone receives a cancer diagnosis, their whole world is turned upside down. Treatment decisions can seem overwhelming, and it is more important than ever to tap into the grounding and healing power that a simple, consistent yoga practice can provide. Then, when treatment begins, there are many side effects that can make recovery quite difficult. Often students complain of fatigue, pain, anxiety, insomnia, digestive issues, reduced cognitive function, neuropathy and lymphedema. Yoga asana, pranayama, mudra and yoga nidra are all helpful tools that can bring balance to the body, ease to the mind, and calm to the emotions.

For the past three years I have conducted research into how these yogic practices may help to reduce the side effects of cancer treatment at the Cancer Support Community (the research is fiscally sponsored by the Piedmont Yoga Community). I have gathered some very promising results this year, especially with increasing spiritual and emotional wellbeing. And the latest project is currently underway. You can read more about the project on my website. Research subjects are currently being accepted into the spring 2015 session, so if you or someone you know is interested, contact me at cherylbrownyoga@gmail.com.

Nina: Do you have any poses and practices do you especially recommend?

Cheryl: Yes, I recommend a very slow-paced combination of gentle movements that will stimulate the lymphatic system, which aids the immune system in distributing immune cells throughout the body. Simple movements such as Cat/Cow pose, lateral bends, and twists can be done lying, sitting, kneeling, or even standing so that students can practice with as much or as little activity as they require on any particular day. Calming and cooling pranayama, such as nadi shodhana, and rechaka kumbhaka, are helpful for reducing anxiety and creating a sense of calm. I also incorporate mudras or hand gestures into my classes because they can affect change in the energy, mood, and awareness of the practitioner. Mudras are simple and can be viewed almost like a yoga medicine cabinet; there is a mudra to help almost any physical, emotiona,l or energetic complaint. Restorative practice is also a perfect way to practice during treatment, especially on the days when there is the intense fatigue from chemotherapy and radiation. And, finally, I would recommend yoga nidra, a special form of guided meditation that is profoundly restful and rejuvenating. I have published several yoga nidra CDs that can be purchased or downloaded from my website.

Nina: Anything that should be avoided?

Cheryl: I would not recommend any intense form of asana practice, such as Vinyasa, Ashtanga, or Bikram, nor would I recommend deep, intense twists, backbends, or inversions. Overheating the body is not advised because traditional western medical treatments create residual heat in the body so the best practices are those that cool, soothe, and calm the body and nervous system. After treatment has ended, students can begin to incorporate more active practices as long as they are comfortable.

Nina: For people with cancer and want to get started practicing yoga, what do you recommend?

Cheryl: Look for a yoga teacher or yoga therapist who has experience teaching cancer patients, and don’t be shy about telling your teacher that you are undergoing treatment or if you have recently had surgery. Find a class that is billed as gentle yoga or restorative yoga. There may also be cancer support facilities or hospital classes in your area that specialize in yoga for cancer patients, so look around for classes designed specifically for those living with or recovering from cancer.

If you’re in the San Francisco Bay Area, I teach public classes in Oakland and Walnut Creek and also make house calls for private yoga therapy. My schedule is online here.

Nina: And for teachers who want to teach people with cancer, what do you recommend for special training? 

Cheryl: I would recommend additional training in yoga therapy or specific training in yoga for cancer patients. There are many great programs out there all over the country. I personally offer a six-month mentorship for 200-hour certified teachers who are interested in working with cancer patients. The mentorship involves attending and assisting one weekly class and three teaching assignments. I am currently accepting applications into the 2015 Yoga for Cancer Mentorship, and you can find out more on my web site. I also teach a weekend intensive Yoga for Cancer teacher training module through the Niroga Institute in May of 2015. You can register directly with them at niroga.org.

Nina: Thanks for taking the time to share all this with us, Cheryl. Your work is inspiring! 

Courtesy of Melina Meza

Cheryl Fenner Brown, PYT has trained with master teachers from Piedmont Yoga Studio and the Integrative Yoga therapy schools, and she blends both traditional Hatha teachings and alignment principles with subtle energy work and healing. Students appreciate her unique blend of philosophy, asana, mudra, chanting, pranayama, and yoga nidra delivered with compassion and humor. Cheryl encourages each student to honor where they are in their bodies every time they step onto the mat so deep healing and transformation takes place.

With over 420 client hours as a yoga therapist, Cheryl sees clients privately and has taught over 3000 public classes and workshops in studios and cancer centers around the San Francisco Bay Area. She serves on the faculty of the Niroga Institute's Yoga Therapy 800-hour and Piedmont Yoga Studio's 300-hour teacher training programs, and offers workshops and retreats for cancer survivors. She also conducts research on the benefits of yoga for reducing side effects of cancer. For more information about Cheryl, see her web site www.yogacheryl.com. To contact her, email her at: cherylbrownyoga@gmail.com.

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Yoga's Healing Powers

by Ram

Morning Glory by Melina Meza

Undoubtedly, all of us who do yoga as part of our daily routine have experienced its benefits, either at the physical, mental, or emotional level or at all levels. We all agree that it is relaxing, it is calming, and above all it has helped us in our flexibility and strength. Additionally, for some of us, yoga has helped in the healing of the heart, brain, gut, colon, kidney, hips, spine, and so forth. And all the anecdotal reports of the benefits that people have raved about are now being proved by empirical findings. In one of the largest studies of health benefits of yoga, it appears that yoga can reduce inflammation, the body's attempt at self-protection. Before I describe the study, let me briefly discuss inflammation and its positive versus negative health effects.

Inflammation is part of your body's defense response; the objective is to remove damaged cells, harmful irritants, or toxic pathogens from the body and initiate a healing response. While inflammation is not infection, an infection itself caused by bacteria, virus, or fungus can trigger an inflammatory process. Inflammation has a high beneficial value. For example, if you develop a viral infection or if your back sustains a severe blow, inflammation sets in to care and protect the injured tissue. The classical signs of inflammation are pain, heat, redness, and fluid accumulation (swelling). Other signs include: fever, chills, fatigue/loss of energy, muscle aches, headaches, and loss of appetite. All these signs are the body’s defensive strategies were activated to ward off the damage and heal the injured area. These defensive strategies are carried out by an arsenal of molecules that fight the invaders. The molecules include but are not limited to: leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and TNF, among others. Thus, the inflammatory process is akin to a country’s defense system involving several units of entities of increasing specificity that culminate in the removal of invaders and promote healing of any damaged tissue. In a perfect setting, the inflammatory process occurs just as it should: releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Now imagine if this body’s strong defense system turns awry and the defending molecules take on their own body’s system (akin to a coup). That would be the negative aspects seen in chronic inflammation, which are characterized by a defense response that is aberrant, out of control, and not completely turned off. Just like a constant, slow-burning fire, in chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed and the body operates as if it is constantly under attack. Thus, chronic inflammation draws on your body’s energy and resources, which can with time result in bodily damage. Additionally, when this system goes out of control, it self-perpetuates and triggers disease conditions, such as, atherosclerosis (inflammation in blood vessels), diabetes (inflammation in pancreatic tissue), arthritis (inflammation in bones and joints), celiac disease (inflammation in digestive system), fibromyalgia, and neuralgia (inflammation in limbs, muscles and nerves), among others. It is as though the body’s defense system fails to distinguish its own self, making the body vulnerable to attacks from its own defense team. The causes of chronic inflammation are numerous and include age, genetic predisposition, smoking, environmental stressors, allergens, chronic stress (both physical and mental), poor foods (sugary, processed, or fast food), and hormonal imbalance, among others.

But there’s good news for those of us who have a regular yoga practice. Several studies now report that a regular yoga practice:

1. suppresses inflammation
2. lowers the level of several pro-inflammatory molecules in the body
3. reduces a subset of pro-inflammatory molecules called cytokines, thereby relieving severe pain associated with the inflamed tissue

More specifically, studies report that yoga reduces inflammation in patients with cardiovascular problems and also improves levels of glucose and insulin in diabetic patients. There are also reports demonstrating yoga’s role in curbing inflammation that may serve as a panacea for people recovering from cancer. It turns out that following several rounds of radiation and/or chemotherapy cancer survivors suffer from persistent and debilitating fatigue for months or even years. Scientists believe that the cancer treatment procedures trigger an inflammatory process that fails to turn off. In addition to the weakness and pain from the cancer therapy procedures, these patients now suffer from inflammation that draws on the body’s resources, resulting in chronic fatigue. It is estimated that about a third of breast cancer survivors suffer from inflammation and chronic fatigue for several years after they complete treatment.

In a recent paper published in the Journal of Clinical Oncology Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial, researchers looked at 200 breast cancer survivors who had completed all the breast cancer treatments. The randomized, controlled trial involved only yoga novices. The yoga group practiced yoga twice a week for 12 weeks with take-home DVDs to practice at home. The control group was wait-listed to receive the same yoga sessions after the completion of the trial. The group that had practiced yoga for three months reported less fatigue and higher levels of vitality three months after the treatment had ended. The yoga group also reported significantly improved sleep. Additionally, three cytokine proteins in the blood that are markers for inflammation were all lowered by 10 to 15 percent. The novelty of the study was that it offered biological evidence of the benefits of yoga in addition to people's own reports of how they felt.

Cancer treatment leaves patients with high levels of stress, fatigue, and insomnia, which may trigger inflammation that in turn triggers tissue damage, leaving the patients completely debilitated and in a downward spiral. As we are now well aware, yoga reduces stress and fatigue (see Stress, Your Health, and Yoga ) and helps people to sleep better (see Sleep: A Pillar of Life), all of which may ultimately block the inflammatory process thus providing immense benefits to the cancer survivors. I guess you would agree with me that you cannot find a better, cheaper, and effective therapy for combating inflammation!

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