Scars Upon Thars and Exercise (data pertinent to cancer peeps) ~ what 57 years and scars can do!

I do not like my scars.  I do not like them on my thars.

I do not like white spots; littered on my back like dots. 

Even though you may not see, they are very much a part of me.

As someone with more than twenty surgical scars and lots of vitiligo, I have given some thought to what they mean to me, society, self esteem, strength, weakness, beauty.

In 2010, there was this:  I finally figured out why...

In 2012, I wrote new words to this little ditty - I feel pretty

I have been inspired by many.  There was this in 2013:  The light that shines.....despite cancer and its scars   This in 2014:  Real beauty? Way more than skin deep!!!!  And this, in 2018, after my second cancer.  No, not second round with melanoma - been there, done that, too - but a whole new crazy cancer diagnosis with multiple surgeries for THAT one!!!  SCARS are more than skin deep. The love that sees me through....  

Before we go any further ~ by way of a trigger warning for those not interested in looking upon gnarly healing surgical incisions ~ I give you this parting pic while you flip the script!!!!

There is no doubt about the beauty of the Jewel Weed!  It is also called "Touch me Not!" because once the flower has faded, a little spring loaded case, looking for all the world like a miniature pea pod, develops!!!  They burst open, spewing tiny seeds everywhere, when lightly touched!

Now....where were we?  Oh, yes - scars and exercise...

I have learned that it takes a minute to process things; all sorts of things.  The same is true for body reconfiguration!  Here is a pic of my grossly swollen abdomen after removal of surgical staples several weeks after my second surgery in September 2018 for ex-goblet cell adenocarcinoma of the appendix -

It's a complicated physiologic and psychological situation.  You have been changed AGAIN, despite every positive action you can possibly take, by circumstances beyond your control.  You look like crap.  You feel worse.  The thought of walking to the bathroom (which you're having to do every ten minutes) feels almost insurmountable.  Going for a run?  Impossible.  Or is it?  

On that day, it certainly was!  How bout after SRS (radiation) to a brain tumor and removal of the right upper lobe of my lung for melanoma?  Again, a big no!  But, with lots of love and encouragement, especially from my girlie, my path back to fitness was a glacial process that started here - Reading this...  Yep.  On May 11, 2010 after the traumatic insults inflicted on April 27 and 30th, I did 10 minutes on the elliptical.  It was slow, supervised and of the lowest level of exertion possible.  But, it was a beginning. Exercising while on the immunotherapy that followed was not easy.  Some days were better than others.  The arthralgias and fatigue were a real challenge.  Many days were like this:  I feel like....  Chemo after surgery for the adenocarcinoma was an almost overwhelming obstacle; as the treatment left me ill and weak.  For days after dosage it was impossible.  But, I kept trying!  In November, two months after surgery, small improvements were HUGE victories:  Ex-goblet cell adenocarcinoma, CAPOX, and the GBD's!!!!  Almost a year later, I finally made it back to Barre classes with my girl:  Sew and LIVE chaotically!! ~ An AMAZING #MeMadeMay Day 7!

So, why do I bother, especially since my desire to exercise on some days is decidedly low!!!?????  Maybe I'm just vain.  Maybe, as I've always been physically fit and exercised, I object to having that part of my identity removed.  Maybe I'm just stubborn.  As a medical professional I have certainly been educated regarding the benefits of exercise - there is far less morbidity and mortality among those who do.  Less disease generally - diabetes and cardiac disease particularly.  Ironically, less cancer!  You gain stronger bones and muscles, better mental health, longer life.  Clearly, regular exercise for the past 57 years has not prevented MY cancers!!!  Still, I know I would have never been able to endure some of the insults cancer and its treatments have inflicted had I not been as strong as I could be.  

In 2013 I published this article:  Jump up, jump around...and fire up those Natural Killer cells!!!  There have been others since about the benefit of exercise and my particular cancers.  Now, there's this:

Voluntary wheel running can lead to modulation of immune checkpoint molecule expression.  Bay, Unterrainer, Stagaard, et al.  Act Oncol.  2020 Dec.

Background: Exercise and physical activity (PA) are associated with reduced tumor growth and enhanced intra-tumoral immune cell infiltration in mice. We aimed to investigate the role of PA achieved by voluntary wheel running in promoting the immunogenic profile across several murine tumor models, and to explore the potential of checkpoint blockade and PA in the form of voluntary wheel running as combination therapy.

Material and methods: The experiments were performed with C57BL/6 mice bearing subcutaneous tumors while having access to running wheels in their cages, where key immunoregulatory molecules expressed in the tumor tissue were measured by qPCR. Furthermore, we tested the hypothesis that wheel running combined with PD-L1 -or PD-1 inhibitor treatment could lead to an additive effect on tumor growth in mice bearing B16 melanoma tumors.

Results: Wheel running increased immune checkpoint expression (PD-1, PD-L1, PD-L2, CD28, B7.1 and B7.2) in B16 tumor-bearing mice, while induction of only PD-L2 was found in E0771 breast cancer and Lewis Lung Cancer. In studies combining voluntary wheel running with PD-1 -and PD-L1 inhibitors we found significant effects of wheel running on attenuating B16 melanoma tumor growth, in line with previous studies. We did, however, not find an additive effect of combining either of the two immunotherapeutic treatments with access to running wheels.

Conclusion: B16 tumors displayed upregulated expression of immune regulatory molecules and decreased tumor growth in response to PA. However, combining PA with PD-1 or PD-L1 blockade did not lead to a further augmented inhibition of tumor growth.

Hmmmm......  There is also this:

Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial.  Van Blarigan, Fuchs, Niedzwiecki, et al.  JAMA Oncol. 2019 Apr 1.

Importance: The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival.

Objective: To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer.

Design, setting, and participants: This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017.

Exposures: We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy.

Results: Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 years. Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42% lower risk of death during the study period and improved disease-free survival. When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival, 0.58 for disease-free survival, and 0.64 for recurrence-free survival.

Conclusions and relevance: Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival.

SO...  Nothing is a sure thing.   But, the data is clear.  High veggie, low meat and alcohol diets with regular exercise are better for all of us - in lots of ways.  Have I prevented cancer in my life?  Obviously not!  But, I'm still here!  57 years and counting! So, after my run today... here are a couple of my scars ~

I ain't J Lo - BAHAHA! - still...  57 ~ what it do!

I do not like my scars.  I do not like them on my thars.

I do not like white spots; littered on my back like dots. 

Even though you may not see, they are very much a part of me.

Despite the lines upon my skin, they do not break the me within.

Strength is not just what you see, but how I deal with adversity.

I AM strong.  Scars be dammed.  I will determine who I am.

Be you.  Timshel.  ~ les