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Healing Refuge

For many women with breast cancer, yoga offers relief from the side effects of treatment while transforming a sense of loss into an experience of wholeness.

By Katherine Griffin, sequence by Jnani Chapman

HealingRefuge_HP

Sometimes the first inkling that something is wrong comes when you're alone. Sometimes it comes when your doctor's number pops up on your cell phone a few days after a mammogram.

What you feel first is the fear—that sudden flash of dread that washes over you, too quickly for you to name. Then you realize that what you fear has a very familiar name: breast cancer. You know women who've had it—many who have survived, some who have not. And you know that if the as-yet-unidentified lump in your breast turns out to be cancerous, you may be facing months of debilitating treatments. You're likely to lose your appetite, your energy, your hair, and perhaps also your sense of your body as a safe, whole place for your spirit to reside.

At such a moment, beginning a yoga practice might seem unlikely.

But that's exactly what Debra Campagna, a former hospital executive in Hartford, Connecticut, did. On Valentine's Day of 2000, her doctors told her that the lump she'd found in her left breast a week earlier was indeed cancer. In fact, it was a large, fast-growing tumor, so she would need the most powerful tools in the Western medical arsenal: chemotherapy, radiation, and surgery.

Campagna, who was 50 at the time, was accustomed to working out at her gym five times a week. She knew she wouldn't be able to keep that up. "I saw a flier for a Kundalini teacher offering private yoga sessions," she says. "I signed up." She'd had no yoga experience but hoped to find the practice gentle enough to continue during treatment. In fact, she was able to work with the teacher once a week for the following year.

Prior to starting chemotherapy, Campagna had two surgeries: the first to remove the lump and the several lymph nodes where the malignancy had spread, and the second to remove stray cancer cells the first surgery had missed. Then, beginning in April, she went through eight rounds of chemotherapy. She also had 30 radiation treatments. Along the way she had to contend with CT and PET scans, biopsies, and innumerable other tests, consultations, and medications.

"It was very frightening," Campagna says. "You wonder, obviously—Am I going to live through this?"

Now, eight years later, Campagna is cancer free. And while she gives grateful credit to what she calls her "amazing" team of doctors for their part in her recovery, she deeply believes that yoga was an essential element in her healing.

"I'm convinced that yoga made all the difference in my treatment," she says. "The breathing was the thing that always came back for me—keeping the fear and panic down. I was in a PET scan machine for an hour. You just lie there and think terrible thoughts. I found my breathing. That was the most valuable thing."

Increasing numbers of women caught in the fear, pain, and uncertainty of a breast cancer diagnosis are turning to yoga to ease their way forward. Some hear about it through word of mouth; others are encouraged by their doctors to seek out the practice. These women—and the researchers who are studying how yoga may be helpful—are finding that the ancient discipline can soothe, comfort, and help them feel whole once again.

"Studies suggest that doing yoga while going through breast cancer treatment helps you get through it with fewer side effects," says Dr. Timothy McCall, Yoga Journal's medical editor and author of Yoga as Medicine. "Often doctors have to stop chemo or lower doses to levels that may not be as effective because people don't tolerate the side effects. But yoga appears to decrease all kinds of side effects."

Being able to gently revive their energy is especially important for cancer patients, because fatigue is the most common side effect of both cancer and its treatment. "Yoga can make a huge difference in a person's fatigue level," McCall says. Last year, researchers at Duke University published a study showing that an eight-week yoga program focusing on gentle postures, meditation, and breathing significantly lessened fatigue and pain in women who were seriously ill with metastatic breast cancer. Other research has shown that yoga can ease the nausea, depression, and anxiety that often accompany treatment.

Special Appeal for Breast Cancer Patients

Yoga benefits people with other kinds of cancer as well. But breast cancer patients seem especially drawn to it. The reason for this may be that they, as a group, advocate for research and support services more than people with other cancers do, spurring researchers to find funding for studies. Once those studies show the benefits of yoga, doctors are more likely to recommend it. Then, too, breast cancer patients are often diagnosed earlier in the course of the disease—when they are stronger and generally healthier—than people with, say, ovarian or lung cancer. That means it's often easier for women with stage I breast cancer to do a strong practice than it might be for people with other kinds of cancer.

But the yoga that breast cancer patients are able to do might not be what you'd see in a typical asana class. What's most appropriate is a gentle approach that combines modified poses with meditation and pPranayama (breathing techniques). Sometimes women are lucky enough to find a class created especially for people with cancer. Or they might learn of a class taught by someone who specializes in yoga therapy. Whatever the setting, the most important thing for patients is to feel comfortable and to go at their own pace.

"I always tell students to check their own experience," says Jnani Chapman, a nurse, massage therapist, and yoga teacher at the Osher Center for Integrative Medicine at the University of California, San Francisco. Chapman (who designed the asana sequence featured here) has been teaching yogaclasses for cancer patients for more than 20 years. She says, "It should feel good. You should feel energized and relaxed afterward, not exhausted." Chapman's primary teacher, Swami Satchidananda, the founder of Integral Yoga, emphasized that there are many paths to the place of peace and wholeness within. "For some, it might be hatha, perfecting the physical body," she says. "For some it might be meditation." Chapman aims to introduce patients to various mind-body experiences that can facilitate healing.

Her classes are held in a room at the medical center that's carpeted (more comfortable than one with bare floors), and participants use thicker-than-usual cushioned mats for added ease. In a typical 90-minute class, Chapman will begin with 10 minutes of check-in, in which participants let the others know how they're doing. Then the class moves on to what she calls "witness practice," a sort of body meditation, in which each person goes within, observing the sensations in the body. About 35 minutes of asana come next, with many poses done in chairs so that everyone, no matter how ill, is able to participate. The rest of the class is given over to deep relaxation, breathing practices, and a brief meditation.

Support for the Divine Self

The groups, Chapman says, become an intentional community of like-minded souls, supporting each other. "People dealing with cancer have been 'specimenized,' she says. "When you've lost body parts and Western medicine is treating you like a thing, not a person, you have to reclaim your sense of self."

Robin Hall, a San Francisco yoga teacher who's now 56 and is modeling the poses on these pages, came to a massage therapy session conducted by Chapman after radiation therapy for breast cancer had burned the skin off part of her torso. "I felt like a monster," she says. Chapman's classes became a place where she could cry, feel safe, and share her experiences with other people. "The biggest thing I learned is that who we are inside doesn't change," she says. "Whether we lose a breast, or two, or can't lift our arms over our heads, that divine essence doesn't change."

Using yoga to access a sense of well-being doesn't have to happen in a class with others. For Leila Sadat, 48, of St. Louis, yoga became a lifeline as she lay alone in her bed for weeks. Diagnosed with breast cancer in 2006 when she was 19 weeks pregnant, Sadat learned she had a stage III estrogen-positive tumor that was feeding off the pregnancy hormones and growing quickly. She had practiced yoga for more than a decade and had done some teacher training with Rod Stryker, founder of ParaYoga. But after receiving her diagnosis, she experienced yoga in a whole new way.

"I knew yoga was more than just physical asana," she says, "but until my body could no longer move in the way it once did, I never fully appreciated it." Luckily, Sadat was far enough along in her pregnancy that it was safe for her to undergo chemotherapy. But in July she began having severe contractions (perhaps triggered by chemotherapy drugs) and was put on partial bed rest until the baby was due.

"I couldn't go for a short walk or anything," Sadat says. "I couldn't do much more than lie on my left side. The motion of my breath kept me from going crazy."

A healthy baby girl, Emily, was born via cesarean section that September. Sadat breast-fed her daughter for one week before resuming chemotherapy. In December of 2006 she had a mastectomy. After the surgery, she began to use asana to help her physical recovery, even though she couldn't move much at first.

All through her illness and its aftermath, Sadat drew strength from an image that came to her during a restorative yoga class, soon after her diagnosis. "I was deep in Yoga Nidra [yogic sleep]," she says. "I had a beautiful vision of being in a garden and falling into a pool, and being purified and coming out healed. I felt very reassured that I was going to be OK."

Having a way to connect to a strong sense of inner peace may even help people heal, McCall says. "There is some evidence that yoga boosts your immune system, perhaps by lowering cortisol," he says. The hormone cortisol is released when we experience stress, and when it is elevated over the long term, it can interfere with immune function, McCall explains. "If you feel it's your job to cure your cancer and monitor it 24 hours a day, your stress hormones will be elevated all the time, which may undermine your survival." Cancer treatments often weaken the immune system, so it's particularly important for people with cancer to keep their immunity as strong as possible; this can help them fight the cancer itself as well as keep other illnesses at bay."

Growing Acceptance

Since Jnani Chapman began teaching yoga to cancer patients, she has seen the practice gradually gain credibility in the medical world: "There are a lot of little hospitals that have yoga classes for cancer patients. There's more acceptance now."

In the city of Boise, Idaho, for instance, St. Luke's Regional Medical Center has been offering yoga to its cancer patients for the past 10 years. The seed was planted when Debra Mulnick, a nurse and yoga teacher, began giving classes to employees in 1998. "One nurse who came to that program was an oncology nurse and cancer survivor," Mulnick says. "It was the first time she ever felt really comfortable in her body. She decided she would love to see this become available to patients."

So she and Mulnick developed a program. "It got instituted and accepted because I was a nurse," Mulnick says. "People knew me." She also brought yoga to physicians in the hospital who were unfamiliar with it. "A committee of oncologists was trying to decide whether to do this," she says. "So I gave a restorative class. I think that cinched the deal."

Sue Robinson, 61, a manager for a telecommunications company in Boise, began attending the class at St. Luke's shortly after she was diagnosed with breast cancer in early 2007. "I've never done anything that seemed to be so simple but had so many benefits," she says. "I would get so in touch with everything in the here and now. The benefits lasted for days."

Teacher Shortage

Still, yoga is far from being a standard part of the therapies offered to women who have recently been diagnosed. One reason, says Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute, is that there are not enough yoga teachers trained to work with cancer patients.

Chapman is doing what she can to change that. Every year she leads the weeklong teacher training program Adapting Yoga for People with Cancer at the Satchidananda Ashram in Virginia. And designer Donna Karan's Urban Zen Initiative is training Integrative Yoga Therapists to use yoga, meditation, healing touch, and aromatherapy with cancer patients at Beth Israel Medical Center in New York City.

Rowland suggests that, as more and more patients experience yoga, they need to make sure that their physicians know how helpful they've found it. "One way I've seen programs accepted is when patients come to their doctors and say, "'Yoga is the best thing I did for myself, and it helped me in these ways,'" she says.

Debra Campagna agrees. She knows firsthand that yoga can be transformative in helping women get through breast cancer. The Kundalini class she turned to as a substitute for the gym was the first step in a journey that's changed her life. "I got so interested in more than just the postures," she says. "I learned to look at everything in my life differently."

When she started yoga, Campagna was very driven. Gradually, as yoga helped her make it through the rigors of her treatment, it became easier for her to let go and receive. "I was more relaxed and less afraid," she says. "More accepting."

After she returned to work, she started sharing what she had learned from her yoga classes with the hospital staff. Then she decided to sign up for teacher training at the Kripalu Center for Yoga and Health in Stockbridge, Massachusetts, in 2003.

"I remember one day standing at Kripalu there in the fog with a cup of hot tea, looking toward the lake and thinking to myself, 'I can change my whole life,'" says Campagna. "From that point I started thinking about not just adding being a yoga teacher to an already full work life, but making that transformation more deeply—having yoga shape who I was at every level.'

Today, she still works for hospitals, doing fundraising and marketing, but only 15 hours a week. She spends the rest of her time working as a yoga therapist, with people who are undergoing various types of medical challenges. She teaches one class for women with cancer, another for people suffering from chronic pain.

What Campagna and her students continue to discover together, she says, is that while illness often comes in a frightening package, it can still lead to beautiful discoveries.

6 Poses to See You Through Treatment

This sequence is designed to help facilitate lymph drainage for anyone in treatment for breast cancer. It is a yoga practice that you can use whether you are currently undergoing chemotherapy or radiation, have lymphedema, have experienced axillary lymph node dissection, or have undergone a partial or total mastectomy.

Before starting to practice this sequence, please consult your team of health care professionals to discuss your particular situation. Make sure to get their approval to introduce these poses into your healing plan.

In order to gain the benefits of this sequence and not cause postoperative harm, back off the edges of any stretch and instead engage in careful, mindful attention to each step along the way. Be sure to rest at the first sign of fatigue or soreness to let your muscles recover.

Try beginning each session by setting an intention—be it for world peace, relief from suffering, or some personal goal. Witness what arises as you coordinate your movements with your breath. Your breath can be relaxed even while it is full and deep. Let each exhalation extend evenly and steadily as you contract the abdominal muscles inward toward the spine. Pumping the abdominal muscles this way will help push the lymph fluid against gravity up to the chest as you move. If your shoulders, neck, or back feel tense when you finish, this is a sign to back off and move more gently in your next session. End practice on a note of gratitude, acknowledging someone in your life or yourself—for your own patience and perseverance.

1. The Hip Walk

Begin by sitting erect on the floor with your legs extended in front of you. As you inhale, consciously elongate your spine upward through the crown of your head so that the pelvis tilts slightly forward and the back is straight. Alternate scooting or lifting first one hip and then the other forward until you have moved to the front edge of your mat. Then "walk" your hips backward in the same way. Continue walking forward and backward for a few minutes or as long as it feels comfortable. Use deep breaths and abdominal contraction on exhalation.

Benefits Boosts energy; activates pelvic and abdominal muscles and massages organs; helps lymph drainage.

Variations You can also hip walk in a chair or in bed. For an added challenge, extend your arms out in front of you, parallel to the floor, and let them dance or swim or hula in the air as you hip walk.



2. The Cormorant

Begin sitting on a chair with both arms extended out in front of you, parallel to the floor or at a slightly higher angle. Bend your elbows to 90 degrees. Throughout the movement, keep the lower arms perpendicular to the floor and parallel to each other, with each hand directly above its respective elbow. Keeping the arms and elbows at shoulder height or slightly higher when moving them allows gravity to facilitate lymph drainage down the arms and into the chest. Exhale as you bring the elbows toward each other in front of you. Be sure to keep the forearms parallel to each other—do not let the hands come any closer to each other than the elbows are able to come. Then, inhale and fill your lungs to capacity to open the chest upward as you open the arms as far out to each side as they'll go. Maintain each hand directly above each elbow. Continue moving through this practice for as long as it feels comfortable. Start small, with a few repetitions; you can build to 8 or 10 repetitions over the course of a few weeks. Rest as needed.

Benefits Activates and strengthens the midriff and chest muscles; encourages healing after lymph node dissection.

Variations You can also do the Cormorant while lying in bed or standing.







3. The Silly Teapot

Sit on an armless chair and place your left hand on your left hip for support when you start moving. Imagine that your torso is a teapot that you are filling as you inhale. Lengthen the spine upward from the tailbone to the crown of the head. Lift the right arm alongside your right ear, pointing the hand toward the ceiling (or bend your right elbow and cup the back of your head with your hand). On an exhalation, bend sideways to the left in a flat plane. Imagine that you are pouring the tea out through the right hand or elbow. Keep your chest open and your shoulders stacked (no twisting or turning) as you tilt sideways, with both sides of the torso long. Return to the vertical position on the inhalation. Repeat the same movement on the other side.

Benefits Activates the inner and outer intercostal muscles (the muscles between the ribs) to help support deeper, freer breathing; stimulates the upward flow of lymph fluid through the trunk of the body and the downward flow of lymph through the arms.

Variation Lace your hand on the seat of the chair beside you instead of on your hip.










4. The Cat Purrs

Sit erect and comfortable on the front edge of your chair with your feet on the floor or supported by a cushion. Place your palms on your knees. Exhale as you tuck your tailbone in and point it forward to round your pelvis and lower back. Continue rounding along the entire spine and tuck your chin toward your chest as you extend the arms forward on the thighs. Then, inhale as you point your tailbone down toward the floor, drawing your hands up along your thighs. Elongate up through the spine to a gentle arch. Lift the chest upward. Exhale each time you tuck and round; inhale each time you extend and elongate. Remember to purr as you relax into the movements of this sequence, enjoying whatever range of motion
you have along the forward and backward axis of the spine. Witness how you feel as you explore your range of movement vertebra by vertebra.

Benefits Increases spinal flexibility; encourages abdominal strength.

Variations Try this on all fours on a cushioned mat. The fists or wrists will be directly below the shoulder joints, and the knees will be directly below the hip joints.







5. The Winding Twist

Stay seated in your chair, lengthen your spine, and reach the crown of your head toward the sky. Rest your feet on the floor, with each knee directly above each ankle. Place your left hand behind you, palm down on the chair seat, and extend the right arm out in front of you, parallel to the floor. Follow that hand with your gaze as you exhale and twist to the left, palm facing left, from the base of the spine. Invite that right arm to stay parallel to the floor. Time your exhalation to finish when you reach the full range of your twist. Then inhale as your right arm returns, with the palm turned in the direction of the movement. As you continue inhaling, let the arm sweep around to the right side of the
body. Continue coordinating the breath with the movement and rest at the first sign of tiredness or muscle fatigue. Switch sides and continue for as long as it is comfortable.

Benefits Stimulates muscles along the spine; massages the internal organs.

Variations Rest the hands on the shoulders or interlace the fingers behind the neck or the back of the head as you wind from side to side. Do this twist sitting in bed or on the floor, but not lying down. (A reclining twist is contraindicated because the weight of the lower body in a reclining twist can put added stress on the spine. The body is already working hard enough at healing, so it is better not to add such extra stress.)

















6. The Settling Self

Lie on your back on a cushioned mat and rest your calves on a chair at a height that allows your knees to be at a 90-degree angle. Rest your arms away from your torso, off to the sides, elbows slightly elevated on soft pillows, and place your hands on your abdomen. You can let the eyes close or use an eye pillow if that feels comfortable. Exhale and draw your abdominal muscles toward the spine as you breathe, and imagine the energy generated from your practice flowing through your palms to nourish your center. Reflect on the miracle of being alive and invite your conscious imagination to direct healing energy through the breath to every cell, every muscle, every tissue, every organ, and every system in the body so that you are envisioning physical, mental, emotional, and energetic healing. Rest here in the center of your being, restoring and renewing the life within you.

Benefits Gravity helps the lymph fluids passively drain toward the front of the chest, where they enter the blood supply to be cleaned by the body's organs of elimination. This pose helps circulation and the drainage of lymphatic fluid. It also calms and balances the nervous system and settles the mind.

Healing Visualization

You'll no doubt encounter rough spots during your treatment and recovery—whether it's during chemotherapy or radiation, before surgery, or just waiting for test results. A guided-imagery meditation helps focus awareness on healing. Follow the practice below by calling to mind the sights, sounds, and sensations that nourish you with a deep feeling of peace and ease. As you lie with your eyes closed, have a friend read the following text aloud. This is a guided meditation for you to try as you actively encourage healing within your system.

Get comfortable Lie face-up on a supportive surface such as your bed or on your yoga mat. Support the head, neck, lower arms, and knees with as many pillows or bolsters as needed for comfort. You can place the lower legs on a chair with the knees bent and lower back in a neutral position. Make sure you are comfortable and your spine is straight.

Go inside Direct your mind to some beautiful place—either real or imagined—where you have a sense of safety and comfort. Let your imagination create a therapeutic refuge. Allow pictures of the scene to form in your mind's eye. Acknowledge this place as your own special healing sanctuary.

Observe your sanctuary Look around—the scene might include sweeping vistas, mountaintops, the ocean, or maybe just an array of colors and lights. Listen to whatever sounds are present—birds chirping, waves crashing, a gentle breeze in the trees. Allow the sights and sounds to soothe your soul and heal your body. Invoke healing images from the tactile and olfactory senses, too—recall textures and fragrances that soothe your soul and bring you peace. Let images into your awareness, affirming that they come to you for healing.

Rest After you have used the sense perceptions to invoke your healing sanctuary, allow yourself to rest there. Watch the breath passively as you imagine receiving everything you need to heal. Rest deeply in the center of your being. When you are ready to come back from your healing sanctuary, use breath and body awareness to return gently and slowly to the present moment. Remember that you can return to your healing sanctuary anytime.

Come back Return often to let your imagination drink from this wellspring of deep healing. Invoke it frequently by taking time to rest in your healing sanctuary, and use your creative imagination to envision the healing outcomes that you desire.

Lymph Notes

When you have breast cancer, various treatments can compromise the healthy functioning of your lymphatic system—the vessels, ducts, and nodes that move lymph fluid through your body. Healthy lymph nodes are crucial to proper immune system functioning, since they contain infection-fighting white blood cells and filter out foreign particles as well as cancer cells. Radiation can damage otherwise healthy lymph nodes and vessels, and lymph nodes may be biopsied or removed to see if they contain cancer cells or tumors. Removing lymph nodes carries a risk of infection or lymphedema (an accumulation of lymphatic fluid in the interstitial tissue that causes swelling). Fortunately, the lymphatic system can find alternate pathways to remaining nodes.

Lymph drains into the blood supply behind the collarbones; the top front chest on the left side receives lymph fluid from the trunk, legs, left arm, and left side of the head and chest, while the top front chest on the right side drains lymph out of the right side of the head and chest and the right arm. Your muscles constantly act as pumps that move the lymphatic fluid along in the vessels. When you engage your muscles with your arms elevated at chest height or higher, you use both passive and active drainage to support healing; with your arms up, you are using gravity to help you passively transport lymph from your arms to your chest, while the muscle movement actively pushes the lymph along in your system.

Sequence by Jnani Chapman, a yoga teacher and registered nurse who specializes in helping people with cancer and chronic illness at UCSF's Osher Center for Integrative Medicine.
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