“You have power over your mind, not outside events. Realize this, and you will find strength.” Marcus Aurelius
There are reams of data regarding the importance of good nutrition and active habits in reducing the risk of developing cancer. Reducing, not eliminating. As a surgical oncologist I advocate the importance of a healthy lifestyle to my patients to facilitate their recovery after surgery and other cancer treatments. This includes regular exercise, eating fresh and healthy food in rational portions, avoiding alcoholic beverages in excess, not smoking or using tobacco products, avoiding obesity, and by managing any other medical problems they might have like high blood pressure or diabetes. I stick to this advice myself, although as a card-carrying chocoholic I must occasionally increase my exercise regimen the day after an indiscretion that included an unnecessary but delicious second piece of chocolate cake. Ahem! For more than a dozen years I coached and refereed youth soccer teams. This meant I had the guarantee of 4 or 5 days weekly of running up and down the soccer pitch with the players. I was never particularly interested in weight lifting as a form of exercise until a patient of mine decided that should change.
I say decided, I should say derided. I was shamed into weight lifting by two years of relentless and recurrent cajolery. I met this man, who would first become my patient but then become my personal trainer and friend, one month after he had undergone an emergency operation to remove a large colon cancer almost completely obstructing his intestine. The colon cancer had spread to lymph nodes near the tumor which were removed by the operating surgeon, but the surgeon also discovered and biopsied malignant tumors in the liver. The patient was referred to me to consider surgical treatment of the tumors that had spread from the colon to the liver. Walking into the examination room, I was faced with a young, extremely muscular man who was pacing back and forth in the room. “Sorry Doc,” he explained, “I don’t do well sitting still.” This was first of many understatements to pass from his lips.
This gentleman was several inches shorter than me, but his chest was massive. His biceps were larger than my thighs. He explained to me that the diagnosis of cancer was very inconvenient (the next understatement) and that he needed to get back to training himself and his clients, including many professional athletes. I reviewed the results of his blood tests and CT scans with the patient and his wife, and I recommend that he receive six months of intravenous chemotherapy in an attempt to shrink the tumors in his liver and, hopefully, to kill any microscopic cancer cells that might be present elsewhere in his body. “I don’t like putting poisons in my body, Doc!” my patient exclaimed. He was understandably frustrated and angry about his diagnosis of cancer because he had always lived an impeccably healthy lifestyle. I have never had a patient in better physical condition or who consistently and persistently ate a rigorously healthy diet. I came to learn that he eschewed fast food, high fat foods, excess calories and carbohydrates, and that he would exhort his perspiring, complaining clients to join him in “a land of fruit and granola.”
After completing six months of systemic chemotherapy that reduced the size of his liver tumors, I performed an operation that completely removed the malignant liver tumors. I found no evidence of cancer anywhere else in his abdominal (belly) cavity. He was up speed-walking laps around the nurse’s station the day following the operation. His recovery continued at a meteoric pace and he left the hospital only three days after his operation. When I saw him in the office one month after his operation, he told me he was ready to resume his strenuous workouts. He also told me that I should come lift weights with him and build “real muscle” because he knew I was athletic and that I enjoyed staying in shape. I laughed and declined his offer, telling him I was afraid of what I might do to my patients’ livers if I had arms like his!
Six months after his first liver operation, a CT scan revealed a new malignant tumor in the right side of my patient’s liver. I performed a second operation that removed the entire lobe of the liver. Once again, he tolerated this major operation like it was little more than a small speed bump in the road of his life. Unfortunately, cancer and other chronic diseases are not convenient, and this man was learning that his supreme physical conditioning, running 10-12 miles a day, working out with his clients in his gymnasium several hours a day, and eating an impossibly healthy diet was not sufficient to prevent the return of his cancer. Nine months after his second liver operation, yet another small tumor appeared in his remaining liver. It was possible to destroy this tumor with a relatively minor operation. One year after this third liver operation, the cancer decided to make an appearance in a new site. Several small lung tumors appeared on his chest x-ray, and a needle biopsy confirmed that the colon cancer had now spread to the lungs. When I shared this news with him in my clinic, he had an expression of shear exasperation and exclaimed, “This is really starting to get on my nerves!” He received another cocktail of intravenous chemotherapy drugs, but during this treatment I was called on to perform a fourth operation on him when he developed an obstruction of his intestine from adhesions (scar tissue). As with all of his operations, he recovered quickly and despite being on toxic chemotherapy that can cause significant or even debilitating side effects in some patients, he continued to exercise vigorously on a daily basis and appeared to be a completely healthy, albeit heavily-muscled man.
After treating this man for over two years and being repeatedly encouraged to “stop by for a workout, Doc,” I finally acquiesced and agreed to come to his gymnasium one Saturday morning. He spent an hour and half showing me proper techniques of weight lifting, and we performed a very light workout. For the next two weeks, I went to the gym two evenings a week and on Saturday mornings and the workouts were brisk but not overwhelmingly strenuous. I quickly learned this was about to change. One evening, he said, “Okay, now you know the proper techniques, let’s hit it!” I lifted more weights in the next hour than I had lifted in the previous two decades of my life. At the end of the session, I was exhausted but he smiled and told me that he was pleased with the intensity of the workout.
His impish smile should have been a hint, but I missed it. The next morning, per my usual routine, I woke up before my alarm clock went off and reached over to turn it off before it began buzzing. Ouch! My arm was really sore. I then tried to get out of bed. OUCH! I hurt in places that I had never hurt before. I spent the entire day agonizingly waddling around the hospital with people giving me odd glances and asking if I was all right. When I arrived at the gym a few days later on Saturday morning, I told him that I had barely been able to move the day after our previous workout. He told me his goal for me was to be “ripped” within six months. I explained to him I wasn’t interested in being “ripped”. I offered that I was simply happy to increase my flexibility and strength. After telling him this, a steadily enlarging smile, openly and obviously mischievous, came across his face. “Doc, you’re in my operating room now,” he explained, “I’ve endured a lot of pain from your operations and the treatments over the past few years, now it’s my turn to return the favor.” Ah, another understatement. This began a five year odyssey of a surgeon, a patient, two men who became friends, multiple cancer treatments, grudging dietary modifications, and lifting a whole lot of very heavy weights.
When I had first met this patient, he had been told by a medical oncologist that he had probably no more than six months to live. He actually survived over seven years. The malignant lung tumors initially disappeared after six months of chemotherapy, but a year later four new tumors appeared in his lungs. A third line of chemotherapy with new drugs was initiated. The tumors shrank but did not disappear. Two of the malignant lung tumors were removed and radiation treatment was used to treat the other two. Chemotherapy, surgery, and radiation therapy worked for a while, but eventually multiple new tumors developed throughout his lungs. Every time his cancer recurred, he was treated with yet another combination of chemotherapy drugs. Physically and spiritually, my patient was a driven man. He pushed his body to perform impressive displays of power. He was always able to out lift and outperform everyone in the gym, including the professional athletes. His quick smile and high-pitched laugh were never defeated by the noxious surgical and medical treatments. He refused to give in to his diagnosis of cancer, insisting he would not be cowed into submission and inactivity by a life-threatening illness. He spent most of the seven years I knew him living with cancer. He was recovering from operations, radiation treatments, or receiving chemotherapy drugs for most of that time. Despite all of our attempts as cancer clinicians, he finally succumbed to his cancer with tumors spreading throughout his lungs. I was at his bedside in the hospital when he died. I lost another patient to this dreadful disease, and I also lost a dear friend.
I have continued my weight lifting workouts 2-3 days a week. I never achieved what my friend, patient, and personal trainer would consider a state of being “ripped”. I am certainly much stronger than I was before I began working out with him many years ago. I exercise regularly and eat a generally healthy diet, but I confess I have steadfastly refused to give up an occasional chocolate chip cookie or three. Every time before I start one of my workout sessions, I remember my friend and I apply the techniques he taught me to maximize results without causing injury. There are days when I use my workouts to release the frustration and angst I feel about my patients who are struggling with recurrent cancer or after they succumb to this disease despite the best efforts by me and my colleagues. After a particularly vigorous workout, I feel it the next day, but it reminds me why we involved in patient care and cancer research must continue to push harder to find more effective treatments for this horrific condition.