You rang the bell. Treatment is over, the appointments thin out, and somebody hands you a sheet of paper that more or less says “go live your life.” Then what? That was the question listeners kept sending Dave after a month of breast cancer episodes, and it is what he and Mike McGann spent most of their Halloween show on.
His answer starts smaller than you would expect. “If you take 50 steps one day, then do 60 the next,” Dave said. That is the whole first move.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
A red sequin jacket, sunglasses, and a costume swap
First, the costumes. It was October 31, so the two hosts traded places. Mike wore Dave’s First Rehab shirt. Dave came in wearing Mike’s red sequin jacket and a pair of sunglasses. “I’m dressed up as Mike and Mike’s dressed up as Dave,” went the explanation for the radio audience, who could hear the joke but not see it. The jacket, Mike said, was a birthday present from Diana and Brian, and it was the perfect one to have Dave try on. Dave’s review: a little tight in the shoulders and the arms, and long enough to reach his knees when he stood up.
For a minute or two neither of them was quite sure who was talking. “I never know who I am,” one of them said, and then the show got back to work.
Before the main topic, Dave made a pitch he makes often: if you are hurting and don’t know who to see, call. He described those conversations as anywhere from five minutes to a half hour, long enough to work out what is going on, who you should see, and whether it is an emergency. Free consultations are available at the clinic, and you call to schedule one. He also mentioned next week’s guest, neurologist Dr. Reed Stone, who is coming on to explain EMGs, the nerve tests most people expect to be torture.
What comes after you ring the bell?
Mike set it up. The show had covered breast cancer at length through October, including Dave’s cousin Maria Kendzierski telling her own story the week before. “When you get to that point where you’re a survivor,” Mike said, “and you’ve probably maybe rung that bell somewhere,” the obvious question is what happens next.
Dave said there are a lot of treatment centers doing research here in our backyard, and he mentioned the Susan G. Komen 5K as one people know. But his own answer came down to two things you control. “You got to get your exercise in and you got to eat well,” he said.
150 to 300 minutes sounds like a lot
The target Dave gave was 150 to 300 minutes of exercise a week. He admitted that sounds like a mountain. Break it down, though, and the low end is 30 minutes a day, five days a week. You start below that and work up.
Walk, march, or run in place
Walking is one of the best things you can do, Dave said. If you can’t walk yet, stand at a kitchen counter and march in place. If you can march and walk and want to work toward running, run in place. Then get one of the watches that count your steps, and beat yesterday by a little. That is where the 50 and 60 come from, and Dave said it gives you something to look forward to the next day.
He does it himself. “If I’m not at 10,000 steps every day,” he said, “I’m running around my pool table to try to get those steps added up.” Mike suggested doing it with the lights off, especially in pajamas. Dave said his wife always wonders what he is up to.
Why small beats big on day one
Mike put the problem in plain words. “Exercise is something that I think people can make way bigger in their mind than it is,” he said. He has used the same add a little each day approach with pushups. It doesn’t have to be a huge undertaking right out of the gate.
Dave added the practical reason. “If you do too much the one day, you’re going to be sore,” he said, “and then it’s hard to get up and get going.” Anyone who has gone from the couch to an hour long class and then skipped the next four knows exactly what he means.
Exercise and the cells that clean up
Dave explained why he leans so hard on exercise for people who worry about the cancer coming back. He was clear that you follow your doctor’s recommendations and stay on whatever he or she has prescribed. On top of that, as he described it, exercise supports the immune cells the body makes on its own: CD4 cells that call in CD8 cells, and macrophages, which he called relatively giant cells that will eat cancer cells. Dave and Mike had walked through the same cells with dietitian Elyse Marrone and Pilates instructor Danielle Armstrong in Episode 18.
Mike admitted this part surprised him. You tend to think diet, quitting smoking, cutting back on drinking. Exercise, he said, “that’s not really the most intuitive thing.”
How much exercise matters for your own situation is a question for your oncology team. What we can say from the therapy side is that a plan you can repeat tomorrow beats a heroic one you abandon on Thursday.
Two thirds of the plate, and why fruit gets an asterisk
On food, Dave kept it simple. “Two thirds of your plate should be what I call colorful, non starch,” he said, meaning vegetables: asparagus, broccoli, cauliflower, eggplant, mushrooms. That is opposed to potatoes and sweet potatoes, the starchier carbs.
Fruit is where he said to be a little more careful, because it raises your glycemic index and your insulin. The grains he likes are whole grain bread and brown rice, which he called better than white rice because it isn’t refined. Mike asked about quinoa. Dave likes it, mixed with peas.
Halloween being Halloween, sugar came up again later. Dave asked people to try to stay away from sugars, and confessed what he used to do with his kids’ trick or treat haul. He would go through it and take out the Snickers bars and the Reese’s, on the grounds that those were really bad for you. “Because those are my favorite,” he said. Mike admitted they are kind of his too. Dave’s actual advice for the night was mild: it’s fun, he didn’t want to be a “David Downer,” just choose wisely.
Alkaline water, and what your kidneys already do
This was Mike’s question, and he set it up with the grocery store. The water aisle used to have three things in it, he said. Now there is water with electrolytes, double electrolytes, water from a particular aquifer. And alkaline water, which some people swear by to change the pH of their body. Mike had seen someone squeeze lemon into alkaline water and get told that was fine. “The whole thing is confusing,” he said.
7.35 to 7.45
Dave’s answer started with a number. Normal blood pH, he said, runs between 7.35 and 7.45, and your body holds it there. Could you shift it by eating and drinking only alkaline things? “You can’t do it through what you eat or what you drink,” he said. The lungs and the kidneys do that regulating. As long as your kidneys are working, alkaline water isn’t going to hurt you, he said, but it isn’t going to help you either. Mostly it changes your urine.
He took on the argument people make for it, too. A cancerous tumor does make the area around it more acidic, Dave said, but that acidity doesn’t cause the cancer. And the cells that could not survive in a strongly alkaline body include your own. So drinking baking soda is not the shortcut it sounds like. Mike’s takeaway: when he was a kid, alkaline “was just the batteries you wanted because they lasted longer.”
Hydrate, from the tap if you like
Where Dave landed was hydration itself. He said you can get the same hydration from tap water, which is free, and that the civil engineers who work to keep drinking water safe think we’re all crazy for buying bottled water. His summary was four words, all the same word: “hydrate, hydrate, hydrate, hydrate.” Dehydration, he said, can make you dizzy and make you fall, which is the part a therapy clinic sees.
Weight training for bone health after treatment
Back to exercise, with a reason specific to life after breast cancer. Staying at a decent weight was Dave’s first point. His second was bone. Some of the medications used for estrogen positive breast cancer work by stopping estrogen, he explained, and that raises the risk of osteoporosis. Mike called it a domino effect he hadn’t known about.
The answer to weaker bone, as Dave put it, is weight training, especially for postmenopausal women whose hormones are already dropping. He described the two kinds of bone cells, one that breaks bone down and one that builds it up, and the goal of keeping the builders busy.
The clinic has a wellness gym in the same building, and Dave said its trainers put people on programs. For days, pricing and how to join, call the front desk at 561-624-4263. Our wellness program page covers what we can say about it, and the wellness and gym FAQ answers the common questions. If you are over 60 and starting from zero, our post on strength training after 60 is a good next read.
Dave’s chair and towel routine
Then Dave walked through something you can start at home. You need a chair and a towel. That’s it.
| Step | What Dave described | Why, in his words or close to them |
|---|---|---|
| Wall slides with a towel | Face the wall with the towel, slide both arms up over your head and stretch out your whole body | Kind of like a downward dog, without getting on the floor |
| Seated reach (if standing is too much) | Sit in the chair with a big Pilates ball and reach forward and back | Stretches the arms and the back, and gets you ready to exercise |
| Sit to stands | Stand by the chair, then sit down and stand back up | The chair is the exercise, and it is also there in case of any balance issues |
| Walking, marching, running in place | March at a counter if you can’t walk yet; run in place when walking gets easy | Build up to 150 to 300 minutes a week |
If wall slides sound familiar, Dave described a version of them for the shoulder back in Episode 8, and it is on our home exercises page with instructions. The chair based moves for the legs are under knee on the same page.
If your balance is off, find out why
Dave made a point of this. If you have balance problems, there are exercises that can help, but first you have to find out where the problem is coming from. He named four places to look:
- the cerebellum, the part of the brain that coordinates movement
- the inner ear
- plain weakness
- the medicines you are taking
Mike called it mind blowing how many different factors come into play. Dave summed up how a lot of people leave treatment: “the doctor says you’re cured, here you go.” Sorting out a problem like a shaky balance is what an evaluation is for. Our physical therapy team does it every day.
Laughter, Maria, and Mike’s wrist
The middle of the show wandered the way Halloween should. Dave told his version of where costumes came from: All Souls Day on November 1, and, as Dave told it, the pagan belief that the spirits came down that night, so people dressed like them to avoid being recognized. Mike pointed out that Halloween is just All Hallows Eve. They swapped sneeze folklore (bless you, to keep your soul where it belongs), reminded everyone to vote on Tuesday, and Dave told a joke about his dog.
Mike turned the laughing into a point. “Laughter is legitimately a good medicine,” he said, “I know that that’s an old saw, but it’s true.” For him it is about mindset: the person who keeps laughing is the person who keeps showing up for the exercise and the diet. Dave’s suggestion was to watch a comedy while you exercise, and Mike added that it’s always going to keep you more engaged.
Every one of us is a unique individual
Dave brought up Maria from the week before. She had told him after the show that she was sorry she didn’t let him talk. “I said, I’m so glad I didn’t have to,” Dave said. You can read her story in our Episode 20 recap, and the screening side in the Episode 17 recap with Dr. Don Goodwin.
Mike took it somewhere useful. There’s no cookie cutter, he said, and that is freeing: you don’t have to start where somebody else started or do it the way they did. His math for anyone starting from nothing: “point zero zero zero one is an infinite increase over flat zero.”
A Kindle, a networking night, and a sore wrist
Then Mike told a story on himself. He had hurt his wrist a few years ago and it never felt quite right. He holds microphones and moves a lot on stage, and he reads in his free time, and the way he held his Kindle strained something until it kept him up at night. He came by the clinic on a networking night, and Dave worked on it. “That initial release was painful,” Mike said, but the main pain was gone right away, the soreness faded over the next couple of days, and months later he hasn’t had even a twinge.
Dave named what he was treating as a scapholunate dissociation, involving two of the small bones of the wrist, and described the work as mobilizing the wrist back into alignment. “My job is to put you back in alignment the way the good Lord made you,” he said. That was one person’s wrist on one evening. Yours needs its own evaluation, and if it is a hand or wrist problem, our certified hand therapy program and the hand and wrist treatment page are where to start.
Vitamins, next week, and a skeleton
Near the end, Dave raised one more thing for people going through cancer treatment. Appetite often drops, and vitamin deficiencies can follow, which he said can cause dizziness and, in some people, even delusional thoughts. He plans to pick that up next week with Dr. Reed Stone. (Mike’s contribution: if you are having delusional thoughts, see him first, since his are worse.)
Dave closed with a Halloween joke. Two lawyers do stressful mediation work against big companies, and one always brings his buddy, a skeleton. Asked why, he explains that he uses the skeleton as his counselor, because “nothing gets under his skin.” Mike loved the setup. “I love a good set like that and then just bang.”
Listen to the whole episode on the Pain 2 Power podcast page, watch the costumes for yourself in our video library, or catch the show live Saturdays at 8:30 AM on 100.3 Legends Radio.
We are a physical, occupational and hand therapy clinic on US-1 in North Palm Beach, and cancer care belongs with your oncology team. If treatment is behind you and you want help getting moving again, building strength back, or sorting out a balance problem, ask your doctor whether therapy makes sense for you, then call us at 561-624-4263 or request an evaluation.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.