I wrote this up first for someone who emailed me looking for advice on running through chemo ... I then cleaned it up and posted it over at the Runner's World forums. I figured I'd also add it to my blog for those who might be looking for this info but aren't members of the RWF as well.

These are my general tips and advice for running through chemotherapy. As much as I wish that no one will ever have use for a thread like this ... It's inevitable more people will be diagnosed with cancer. This post is not intended to be definitive by ANY means, but for those facing the daunting prospect of chemotherapy, I hope this post provides some of the guidance and help I was searching for when I went through chemo three years ago.

First, the disclaimer: This is *not* intended to replace the advice of your oncologist or his/her staff. Always ask your medical team when you have questions. Make sure you check to make sure running is ok with them while undergoing treatment.

About me ... As you will learn if you surf my blog, I was diagnosed with Hodgkin's Disease (Hodgkin Lymphoma) in February 2007. I had very advanced stage disease. My abdominal mass was 14 cm. My chest masses were even bigger than that. The disease was in my liver and in my spleen. I was treated with 8 cycles of ABVD chemotherapy. (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine.) I was a runner for several years and was able to run through chemo with some modifications. ABVD causes your prototypical chemo side effects -- nausea, hair loss, fatigue.

General Stuff to Keep in Mind

What is chemo like? I would consider the chemo I got on par with a case of the stomach flu -- but with less throwing up (I didn't actually throw up during chemo; I did come very, very close on a few occasions but my stomach was empty). Do you want it? No, of course not. Is it horrible? Well, for most people, at times you will be somewhat miserable. But is it something impossible? No. I would feel sick immediately after, and then for a few days after. I would feel just sort of sick -- malaise, disinterested in everything, just wanted to lay down, no appetite, tired.

So here are a few things to keep in mind about chemo:

- Chemo varies. Most people have a preconceived picture of what chemo is, but in reality, chemo varies significantly. The reason is different cancers are treated with different chemotherapy drugs and agents. How you are affected by chemo depends on what drugs you receive, in what dosage, and in what combinations. Therefore, your best source of information will be someone who received the same kind of chemotherapy you will be receiving. Your side effects also can depend on what sort of havoc the cancer itself is doing. (I think my first chemo treatment was horrible mainly because I was so sick from cancer.) However, please know that even people receiving the same drugs don’t always react the same way. Which leads me to point two …

- Not everyone gets every side effect. The two side effects people most associate with chemo are nausea and hair loss. Yet not all chemo causes nausea and not all chemo causes hair loss.

- But … Most chemo will cause some degree of fatigue. But you can fight this fatigue by running. (I know it may seem counter-intuitive but it works.)

- Don't be afraid to ask for help. Doctors, nurses, fellow survivors, family, friends.

- Take it one day at a time. If one day is too much, then focus on getting through the next few hours. If that's too much, then focus on getting through the next half hour, the next minute, the next few seconds.

- You will go through rough patches. Most everyone does. It's ok to get angry, frustrated, to cry. Just make sure you dust yourself off and keep going forward. Relentless. Forward. Progress.

General, Non-Running Related Tips for Chemo (aka some stuff I learned the hard way and think you should know):

1. If your chemo drugs make nausea likely, take your prescribed medicine on schedule even if you do not feel sick. Nausea is easier to prevent than it is to treat. There are a lot of anti-nausea meds and they range from Compazine all the way up to Emend. If one doesn’t work, try a different drug or combination of drugs.

2. Be careful of associations. Evolutionary-wise, we are set up to avoid things that make us sick, and that can cause "anticipatory nausea" and link things we do / smell / eat around chemo to getting sick. This especially includes what you eat, soaps, and candies/gums you chew on during treatment. Even if you don’t get much nausea, many people will begin to associate what they eat with chemo and it can wreck your favorite foods. Smells are also something that creates a strong association. You don’t have to avoid your favorite things for the entire time you’re doing treatment, just be careful the day before, the day of (especially), and in the first few days following treatment.

3. While keeping in mind the above, consider bringing some sort of hard candy or gum to chew on … I think plain saline tastes like chemo and it still makes me gag.

4. Chemo can be given in a variety of ways. If you’re in for a long-haul course of intravenous chemo or you have poor veins, I would seriously consider a mediport, which is a small device that gets implanted (usually in your chest). My oncologist didn't even offer me a choice on a port. A port will save a lot of wear and tear on your veins. As a bonus, you can usually get chemo faster through a mediport than you can through a cannula in your hand or arm. I ran thousands of miles with my port without any issues or problems, but if you have questions, feel free to contact me.

Nine good reasons to run despite doing chemo:

1. Exercise will help keep your sanity.
2. Exercise will help you maintain muscle mass and your bone density.
3. Exercise can help avoid weight gain which is common with some types of chemotherapy that involve hormones and/or steroids. (Yes, some people DO gain weight on chemo!)
4. Exercise will keep your heart strong. Chemo can be hard on the heart. (Adriamycin is one drug known to potentially cause heart symptoms.)
5. Exercise may improve your prognosis. No, running does not cure cancer. But there are some limited studies that show people who exercise do better. The stronger your body is, the better you'll be able to tolerate treatment, stay on schedule, and finish the course.
6. Exercise will help fight cancer related fatigue and as long as you don't over do it should help your counts recover faster.
7. Cancer survivors are at higher risk for secondary cancers and for things like heart disease. Exercise is known to play a role in preventing certain kinds of cancers and heart disease.
8. Exercise often helps with side effects and lessens their severity and duration.
9. Exercise helps with the depression and anxiety that often go with cancer.

Running Related Tips for Chemo

Of course, you don't really need these reasons. You are a runner. Running is what you do, it's part of who you are. I can't say whether you'll be able to run through chemo (see above about variations in regimens and individual reactions), but many of us here have. You do need to be smart and realistic about it, however. The following are some running related tips.

1. Running should be a source of stress relief, not an added stressor. This is one of those times in your life where you need to throw away your watch and just run because you enjoy running. This is not the time to train hard for a race. The fatigue and side effects chemo causes are simply not conducive to hard training or to following a strict training plan.

2. Chemo can be cumulative, meaning it often gets harder the longer it goes. Be ready for this.

3. Listen to your body. As runners, we’re used to pushing ourselves out the door to run even if we don’t feel like it or don’t want to run. There may very well be days when you feel sick or worn down and on those days, cut yourself some slack and don’t run. If in doubt, go out for a walk. If you feel better after a half a mile, you’re probably ok to run. But don't be a slave to a schedule. (See above.)

4. Be careful of comparisons. As I stated above, chemo varies widely. Do what YOU can and don't compare yourself to others or even to your pre-cancer self.

5. Always be realistic in your expectations. Remember, you have cancer and you're doing chemo. Your body is going through Hell.

6. Be willing to slow down. Walk if necessary. Even just getting out and walking if you don't feel well enough to run will help you maintain muscle mass and keep your blood flowing.

7. Hydration is very important. It helps flush out the chemo. My worst treatments were ones where I didn't drink enough water. Err on the side of caution when running and bring fluids.

8. Watch your counts. You’ll become pretty familiar with your CBC (complete blood count). The three main components to be aware of are your white count, red count, and your platelets. Generally speaking, chemo will lower at least some of your blood counts.

Your white blood cells fight infection. If you are low on white blood cells (neutropenic), you are more vulnerable to infections. If you are low on WBCs, you need to exercise extra caution when going to the gym or even avoid it altogether until your counts recover.

Your red blood cells (including hemoglobin) carry oxygen around the body. If you are low on red blood cells, you are anemic and are likely to feel breathless. You’ve seen people complaining on the boards here after donating blood about how running is hard? That’s because they’ve lost some red blood cells. If you are anemic, check with your doctor before running. You will definitely need to slow down and take it easy. (I had severe anemia from cancer and it resulted in a much faster than normal heart-rate from my heart struggling to keep oxygen around my body.)

Your platelets are important to making your blood clot. If you have a low platelet count, you may need to not exercise until it comes back up. But generally speaking, I think your platelet count has to go down a lot before you will end up restricted. (Mine was 80,000 a few times and I was still allowed to run.)

9. Be knowledgeable about your particular chemo drugs and be aware of possible exercise-related side effects. For example, some drugs can cause photo sensitivity or can make you more susceptible to overheating. Don't forget to check your side effect meds as well (for example, your anti-nausea meds).

10. Don't give up. Even if you can't run a step, keep fighting. You may not be able to run through chemo. You may have to start over. But keep fighting. In the summer of 2007, if you asked me if I would ever run a 1:43 half-marathon, I would have laughed at you. I could barely run around my block because of pulmonary damage from the chemo I got. The human body is amazing. Keep struggling and don't give up hope.

If you ever want to "talk" to me, you can comment below. Comments are held for moderation (spam control method), but I generally look at the blog every day. If you prefer to talk to me privately, you can email me at jgoellnitz AT gmail.com.