chemo /// lifestyle

Without stating the obvious, chemotherapy has a major impact on your lifestyle. Some impacts are imposed, some of those can be self-imposed. While not exhaustive, I've tried to capture the main effects on four components of my lifestyle, being:

• Work

• Social Contact

• Exercise

• Nutrition

Similar to the "reader's warning" posted in other posts of this blog, each person's journey and body reaction to chemotherapy is their own, so what I've done (or not done) shouldn't be taken as gospel.

WORK

I am extremely fortunate that my employer (a large sports brand here in Germany) was behind me 100% during this journey, and most importantly relieved any unnecessary pressure from me from a professional perspective - not just during chemotherapy but since diagnosis. Flexibility was by far and away the key ingredient my company gave me - the flexibility to work where, if, and when I felt well enough - and crucially, only if I wanted to. I know it's not the luxury that everyone who goes through a major illness has, but thanks to my employer and my disability insurance, if I wanted to I could have taken the full 2+ months off work during chemotherapy and afterwards during recovery, if I wanted to.

That is not what I wanted, however. I wanted to continue working to be able to maintain some purpose, normality, and ultimately to have a distraction when I needed it. I also felt the buildup of work and a full disconnection would actually create more stress and anxiety than staying at least partially online during chemo.

Thus, throughout the program I worked part time and of course fully remotely (the office otherwise being a great place to catch sickness from colleagues). Oftentimes, as mentioned in another post, I worked in the mornings before my chemo drugs would take hold. Sometimes, even on a day without infusions where I expected to feel well enough - it just didn't happen for me and I chose to stay offline or sign off early. This was sometimes hard for me - I'm someone who prior to my cancer diagnosis hadn't taken a full day off sick in over 10 years. And there were a few days where work created a lot of anxiety for me; not because of the volume of work but because of my own doubts about my capacity and drive - but that's a story for another post.

I did my best to listen to my body though, and I am very grateful for the flexibility granted by my employer.

SOCIAL CONTACT

With my immune system suppressed, normal life and social contact (similar to going into the office physically) was off the cards. My wife and I basically went back into pretty restrictive Covid-19 social distancing protocols:

• Socializing with friends: only in an outdoor setting and never with anyone who was sick or had been around someone sick

• Restaurants: very rarely and if so, only outdoor seating

• Shopping: if I went into a grocery store etc., only with an FFP2 mask

It was hard to go back to pandemic life, especially when there was no actual pandemic and everyone else was going about life normally, but sticking to these rules helped me avoid any illness during the program - which could have of course resulted in serious impacts for me and additionally a delay in completing the program.

EXERCISE

A savior!

My doctors were a little astonished at how active I was able to remain during chemotherapy, but they definitely encouraged it as being great for my body (and mind) and so I continued to try to get moving and sweating whenever I could, without overdoing it.

The first 1.5 weeks of each of the 3 cycles, it was basically impossible to to manage anything other than a short walk - but in the back half of the cycles, I was able to get back on the pavement, trails, and links and it felt great - even if my pace was extremely slow and my golf game even worse than usual. During my 63 days / ~ 2 months of chemotherapy (where only ~50% of that I was out of zombie mode), I managed:

• Running & Trail Running: 15 runs totaling 84 km at an average (snail's) pace of just under 6 min/km

• Hiking: 9 hikes totaling 85 km, including one monster hike (for our standards) of 19 km and 670 m elevation gain

• Golfing: 3 rounds of 9 holes, too many double bogeys to count

The above may look like a brag - and partially it is (I'm allowed, I'm a cancer patient) but hopefully also provides a little encouragement that it's possible for chemotherapy to not be 100% doom and gloom. The body is an amazing thing!

NUTRITION

Similar to how my wife and I approached nutrition during recovery from surgery, we really saw this as one area where we could take some control and have a positive and complimentary impact alongside the chemotherapy. Again, while the science out there is far from conclusive, and I didn't receive any direct instructions from doctor's other than "try to eat healthy", we integrated a few rules into our diet to try to maximize what "healthy" meant, piggybacking on some of the anecdotal evidence online and in print about nutrition's potential impact on cancer survival:

• Ketogenic: OK admittedly, I failed to maintain this one. There are suggestions that a super low carb / sugar diet can help "starve" cancer, which is a metabolic disease. However, I didn't make it past 1 week on keto. It was making me feel sick thinking about eating more butter, cheese, and bacon, and I was missing the freedom to eat fruits and veggies in whatever amounts I wanted. So, we instead just cut all added sugars and went on a very low carb diet - no starchy food, etc.

• No processed food: only whole foods and water/tea. I missed Coke Zero and my protein bars the most :(

• Omnivore: although normally I try to eat a mostly plant based diet (flexitarian), we broke from this rule during chemotherapy and had animal protein daily in order to ensure I was getting enough protein and other nutrients naturally while my body was under stress and fighting the effects of the drugs

• No alcohol: perhaps an obvious one - though I did allow myself a celebratory beer on the last official day of the chemo program

• Intermittent fasting: I continued my daily intermittent fasting program (16-18 hours fasting each day) but added a long fast at the beginning of infusions each week - 48 hours of fasting (only water and tea) comprising the 24 hours leading up to the Monday infusion and 24 hours after. I also listened to my body and if I really felt eating would help, I would break my fast early without thinking twice

• Supplements: my darling wife gave me a handful of vitamins and supplements every morning to take and kept track of what I needed and when, the most important ones being Vitamin D, Vitamin B12, Vitamin K, Zinc, Magnesium, Turmeric, Sulforaphane, and Beef Organ. She also had my nurses check additional levels in my blood tests to make sure I was getting enough (or not too much) of those values

I've said it in another post as well, but my wife Jo was an angel in terms of researching and formulating most of our nutritional program. She read books, researched online for hours, and listened to hours on end of podcasts to help triangulate and make sense of all of the noise out there. As I mentioned, the science is not airtight here, so our approach was to take measures that at the very least wouldn't be harmful, and at best might help maximize my chance of being cured. While the sample size is 1 here and everyone should take their doctor's advice first and foremost, the above program did result in only minimal nausea, relatively minor weight loss (3.4 kg), and a very healthy appetite throughout. It's impossible to say if those outcomes are the result of these nutritional principles, but they were good outcomes nonetheless.

celebratory beer on the last official day of chemotherapy, the longest I've gone with no alcohol since high school