It's My Cancer and I'll Flip If I Want To

I can't believe this: I'm hungry again. Not just bored hungry, not just a little case of the munchies hungry, but serious, stomach rumbling, light headed, blood glucose plummeting HUNGRY. Again. Hell, I just ate.

I try to eat a healthy, balanced, protein rich meal approximately every two hours while I'm awake, and yet I always seem to be starving. Even when I'm in the throes of the Big Ick, even when I'm riddled with mouth sores and throwing up every fifteen minutes, I'm hungry. It's a lot like pregnancy, where my body is convinced that the nausea would go away if only I could satisfy some grotesquely weird craving, the proverbial pickles-and-ice-cream thing.

So I'm frequently cursed with a rabid craving for exceedingly unfortunate combinations, nasty things like greasy take-out andouille fried rice from the Asian Cajun Drive-Thru served with sardines and Tang. (Yeesh, just reading that sentence would probably drive poor Alice Waters to commit seppuku.) Kowtowing to a bizarre craving works for about ten minutes, after which the nausea resumes full force and I can never bear to look at or even think about those hideous ingredients again for the rest of eternity.

But none of that stops me from being stark raving, foaming at the mouth HUNGRY. All the fricking time.

As many of you have probably guessed by now, this is the Prednisone talking. I take 100 mg of Prednisone, a synthetic corticosteroid, for the first five days of every three week chemotherapy cycle. I take it for its anti-inflammatory and tumor shrinking benefits, but I also get saddled with a shitload of its nasty side effects, including but not limited to: immunosuppression, slow healing, catabolism, fatigue, severe insomnia, depression, indigestion, edema, aching joints, muscle pains, restless legs, facial swelling, and, yes! a dramatic increase in appetite.


Facial swelling: the typical goofy Prednisone moon face. (Falling off the fashion grid is also, apparently, a lesser-known side effect.)

Although most folks associate cancer with skeletal weight loss and wasting away, it's not uncommon for cancer patients taking Prednisone and/or hormonal treatments during first-line chemotherapy to rapidly gain a huge amount of unwanted weight. I've read on various lymphoma support boards about people who gained fifty unwanted pounds or more during four months of chemo. Many breast cancer patients have it even worse. This kind of weight increase results not only from adding body fat, but is exacerbated by the loss of lean muscle caused by catabolic drugs (i.e., Prednisone) and extensive inactivity.

Recent medical evidence indicates that even moderate weight gain may be associated with an increase in relapse and cancer-related deaths:

Women who gained only a moderate amount--on average about six pounds--were 35 percent more likely to die from cancer than those who maintained their weight. Women who gained larger amounts, averaging about 17 pounds, were 64 percent more likely to die from cancer.

So there's this uncomfortable dilemma: gaining weight may kill you, but the drugs that are supposed to be saving you do their damnedest to force you to eat yourself to death by packing on excess adipose tissue, which stores excessive toxins from the chemo and so forth. It's an ongoing struggle.

Ok. I'm well aware that the whole topic of weight is a touchy and reactive subject for many people. Let me make it clear that my first priority is and has long been optimal nutrition for good health, not being fashionably thin. My motto is: "I don't want to be skinny; I want to be strong."

Now with that in mind let me tell you a story. Before I had cancer, back in the days when I was a dedicated athlete, I used to frequent an online fitness nutrition and weight lifting board. I learned a lot there because the extremely knowledgeable owner of the board demanded rigorous peer-reviewed scientific studies backing every claim. Unlike the majority of the bodybuilding and fitness boards out there, it wasn't all about anabolic drugs, and there was no tolerance for silly woo, blind tradition, superstition, spam, or bullshit product shilling. It was about achieving excellence in fitness and athleticism through sound knowledge of physiology, kinesthetics, molecular biology, and other relevant branches of evidence.

Granted, there was a pervasive amount of adolescent macho posturing, sexism, racism, and porn worship. But I managed to minimize these blights by sticking to the brainy scientific forums (my favorite was called "the Nerd Shit Forum") and reading a few favorite training logs. In addition to the muscle building and nutritional knowledge I gleaned, I developed some real enduring friendships on that board.

So when I was diagnosed with cancer, I started a new training log over there as a way to keep track of changes in my body composition during treatment. I was especially concerned about monitoring muscle loss, but also wanted to keep track of any changes in weight, up or down. This log was also a place to hang out with my old weight lifting buddies, and some new friends jumped aboard, and all in all it was a great source of support for me in those horrible, lonely, frightening early days of my illness (as opposed to these horrible lonely frightening middle days of my illness).

One day my friend Kimberli posted a pointer to another board where a woman who had just finished treatment for lymphoma was keeping a log. This woman had gained 50 pounds, and was now documenting the months she spent dieting, exercising, and taking some dubious (imho) supplements in her successful effort to shed the unwanted chemo weight.

After reading about her travails, I commented on my own log:

I got the fear of the Bejeebuz reading that she gained 50 pounds. Gah. But from what I've read on the lymphoma boards, this is not at all unusual, mainly because of the Prednisone. Combined with inactivity, a deep need for any scrap of comfort, and ignorant doctors who say eat calorie dense foods to keep up your strength.

And before long the following comment appeared in my training log from the owner of the board. Now bear in mind, this is a very intelligent man, an accomplished middle-aged adult, a well-known expert in the field of fitness and nutrition, the author of at least five scientifically based books about crash dieting, rapid fat loss, and how to achieve "super leanness." He said to me:

Ok, since apparently everyone is too busy telling you how gret you're doing you need a serious fucking reality check.

Do you realize what the disease is that you have?
Cancer

It is a stone cold killer

and yo'ure worried about gaining weight?

are you fucking stupid?
no, we all know yo'ure not stupid.

your body is trying to fight against chemo and the disease and you're being a retard about not wanting to eat enough

don't worry, being dead will keep you skinny

Charming, no? I politely told him to back the fuck off, that I wasn't trying to starve myself or lose weight, that I didn't have an appetite problem because of the Prednisone, and that my doctors, who were NOT ignorant, had advised me to eat a balanced nutritious diet and to maintain my weight. There is scientific backing for this advice. Someone else said that perhaps he'd misunderstood my goals, and a few others chimed in, and blah blah blah. But something about cancer had triggered his ire, and the board owner was on a roll. He went on:

Who the fuck said anything about body recomp?

She's afraid of weight gain because thoes 'ignorant doctors' (you know, the ones trying to save her life) think she should be eating calorie dense foods. Dam straight given that appetite is a problem and cancer tends to cause tissue wasting (called cachexia). Lose too much LBM and you DIE. And what prevents that? Eating food. And when appetite is fucked, what do you do: you eat calorie dense foods. Which is what it sounds like the 'ignorant doctors' told her.

But hey, maybe she can stick with the CR regimen and truly starve herself to death

I mean, it worked to well for her to this point.

she's worried about weight gain and keeps trying to maintain her exercise routine in the face of cancer

she's in denial is what she is

but you guys feel free to keep encouraging this crap

A minor flamewar ensued, with some friends jumping on my bandwagon and some of his lackeys jumping on his. I finally ended up leaving the board altogether, because you know? Life is just way too damn short to waste precious energy hanging around such unbridled assholery.

But there's a tiny moral to the story, and it's this: having cancer is a lot like pregnancy in yet another way, besides the puffy ankles, nausea, and weird cravings. It seems to be an open invitation for intrusive strangers to shower you with uninvited amateur medical advice and regale you with horror stories. And no matter what decision you make about your treatment, some irrelevent asshole with pronounced boundary issues is going to vehemently disagree and loudly predict your imminent doom to whomever will listen.

But you have to stand your ground. It's your life, your cancer, your survival that's at stake. And this, my friends, is why the great benevolent Flying Spaghetti Monster gave us tall proud middle digits on both hands. If cancer doesn't teach you anything else, it will teach you to use them wisely and to use them well.


The author after enjoying yet another stack of delicious high protein 27-grain pancakes with organic raspberry preserves.