I hope this update finds all of you who have been WEIRSTRONG with me well and formidably socially distant.  These certainly are strange and unprecedented times in which we find ourselves.  All of us are hyper-analyzing every cough, sneeze and body ache we experience, wondering if it's allergies or the beginnings of something much more sinister -- welcome to the mental health gymnastics experienced by a cancer patient!

I am pleased to be on the Remission side of things, and I am hoping to be on the Cured Team eventually.  I am now facing the next two phases of my life: Radiation and Cancer Prevention.  I've learned a LOT more about Radiation, something I knew almost nothing of, and I'm going to be spending the rest of my life barricading my Angela cells against  this horrible disease.

Radiation 101.  I just took this crash course with a fantastic University of Maryland Medical School grad and radiation oncologist, Dr. Grace Kim, on Monday at Duke Raleigh.  While the rest of the hospital and the world was scattering to face the dreaded COVID-19, I was sitting in my still immuno-compromised state, learning how I can do my best to remain healthy while any trace of cancer cells will be zapped out of my breast, chest wall, and armpit.  I have a series of not-so-artistic hashmark tattoo (actually just black Sharpie) marks all over my abdomen and breast, and those will be their mapping for my first of fifteen radiation treatments starting next Wednesday.  Radiation is actually pretty simple.  I'll be on a table taking instructed breaths, and they will deliver cone-shaped radiation beams across my chest.  I'll do this for 20 minutes, every day for fifteen days, and I may experience mild burning to my skin and fatigue at the most.  My radiation dose is fairly low because weak, little, bully-jerk Lymphoma cells are quickly destroyed by radiation just as they were by chemotherapy.  The only thing I don't have an answer to is what happens if I have to be quarantined for virus exposure mid-treatment -- how will my treatment still be effective if I have to take a break?  Like everyone else in acute care these days, they are "working on a plan" for that.  I am quite aware from my own job that hospital practices and protocols are proactively and reactively changing multiple times daily these days.  If all goes as planned, I'll be finished with radiation mid-April and my only cancer-related treatment going forward will be hematology oncology appointments every three months for two years and then every six months for three more years.  

Cancer Prevention.  How many magazine articles have you seen touting the latest and greatest cancer prevention lifestyle choice or food source?  It requires much more than adding elderberries or turmeric to your morning smoothie.  Dr. Kim actually talked clinical studies and spoke my Love Language by providing evidence-based practice.  I had an Epiphany (key word here: my upcoming blog will be called "Everyday Epiphanies!" -- don't google it yet, I've bought the site but I'm still figuring out how to make the dang page look decent and I'm just beginning to get my big-girl grammar back after months of chemo brain) that suddenly, the overly-used cliche of "cancer prevention" is quite relevant and acutely imperative in my life.  Studies have shown that I will reduce the risk of cancer recurrence by making a few lifestyle changes.  First, we discussed making my diet more plant-based.  While Chris and I rarely eat out and cook most of our meals at home using real food, we both confess that we eat entirely too much meat. We will be centering our meals going forward around vitamin-rich vegetables, fruits, nuts and grains, and accessorizing with some lean meats. Our primary source of animal proteins going forward will be from eggs, fish and chicken, and Chris' Big Green Egg smoker and griller will have to be satisfied with that.  She provided evidence from study after study that showed why this lifestyle choice is beneficial to not only cancer-survivors, but everyone.  EAT MORE PLANTS.  

Second, adding daily exercise will reduce my risk of cancer recurrence by 30%.  Those are significant enough odds to get my soft butt back to work immediately.  The timing is perfect, because the chemo-induced fatigue is finally dissipating and I have officially broken up with my extra-marital lover that has been my couch.  From our house in North Carolina, we can take a beautiful 4-mile walk around a nearby lake.  We also have miles and miles of bike trails around the Raleigh-Durham area, and bunches of kayakable lakes near our home.  I have already started my socially-distant exercise routine, and I'll be getting my yoga game on in the privacy of my house as well. Suddenly, the motivation to exercise is not just to lose weight or get healthy, it's to stay alive, and that is a much more powerful motivator for me.   

Third, adding 20-30 minutes of meditation/prayer to my routine every. single. day.  I've started and stopped this I don't know how many times.  There are studies that prove that by incorporating this period of mindfulness and stress reduction, the flora of our guts, or the "good bacteria," become stronger and full of increased immune-boosting agents.  I'm going to resist getting technical with this and teaching you about Peyer’s Patches, but there is a synergy between diet, exercise and reducing epinephrine and cortisol  that has proven to make the body's immunity stronger.  The stress-reduction is going to be my biggest challenge because of all the other things that fill my life with worry and anxiety. But those stressors are going to be there whether or not I try to combat them, so I might as well make my soul stronger to diminish their impact on me.  

Finally, since January I have been trying to reduce the toxins in my world.  The biggest one is plastic.  Plastic leads to an inflammatory response, which further debilitates immunity.  Have you ever tried to reduce your use of plastic?  Good God, it's everywhere.  I've started small, with my water bottle, food containers and dishware.  When I'm purchasing things (well, in previously normally-stocked grocery stores), I avoid plastic food containers where possible and opt for cardboard, glass, metal or open.  Simply by being aware, I have probably reduced my plastics exposure by 30-40%.  I have also begun reducing alcohol intake, and replacing a nightly glass or two of wine with tea or seltzer.  I'm not ready to abandon wine completely yet, but I'm conscious of it and trying to minimize how often I use it simply to decompress or relax. 

Dr. Kim said something I've never heard before: "Small piles of dust can make a mountain."  She encouraged Chris and I to start with doable changes and increased awareness.  She also said to be forgiving of ourselves and not be militant - to enjoy celebrations and occasions how we want, but to make an overall shift in thinking toward a cancer-preventative lifestyle.  Meanwhile, I'm embracing my inner House Hermit, and only exposing myself to risk when I have to be at work.  

Stay isolated my friends, wash your hands, and take this forced sabbatical in life to decide which piles of your dust you can make into a mountain.