After cancer treatment, people are often elated that the worst is over, and then quickly sobered by the fact that they don't feel well. There is no doubt that cancer is a disease that takes a tremendous physical toll. No one knows this better than someone who has been through treatment for a head/neck/oral cancer. Wilfred Sheed wrote of his experience with radiation treatment for oral cancer in his memoir, In Love With Daylight: A Memoir of Recovery. Sheed noted, "As the [oncologist] reads off the list of possible side- and after-effects, to run concurrently and forever, it's awfully hard to remember that this guy is supposed to be on your side. There he is, about to kill off thousands of your favorite cells, adding up to a large tract of the body that brought you this far, and they call this man a healer! Talk about bombing villages in order to liberate them; talk about napalming whole forests on suspicion. For all anyone knew, I might not even have cancer at this stage. But bomb we must. One can't be too careful." In her memoir, A Season in Hell, Marilyn French who was diagnosed with esophageal cancer wrote this about physicians, "Simply to treat cancer means they must violate the primary tenet of their code: First, do no harm."

The current treatments for cancer, while providing significant opportunities to patients for prolonging their lives, remain very toxic. In fact, very often for someone diagnosed with a malignancy, the illness is causing few if any problems at the time of discovery. This means that patients often feel much better physically at the beginning of cancer treatment than at the conclusion.

I am a breast cancer survivor and a rehabilitation doctor at Harvard Medical School. When I was going through cancer treatment, I realized that I would have to work hard to heal myself. However, I was exhausted, so I focused on the key things that are important in physical healing. I wrote about these in my book After Cancer Treatment: Heal Faster, Better, Stronger (Johns Hopkins University Press). In this article, I will focus specifically on how to help you get started on the path to healing well if you've undergone treatment for cancer.

No matter what kind of cancer you have been diagnosed with, what stage it was at the time of diagnosis, what treatment you have undergone and where you are in the healing process, now is as good a time as any to work toward healing optimally. Though there are a number of important concepts in physical healing, to get started, consider these three steps:

Step 1 - Heal like you're an athlete.

Physical therapist and sports trainer, Bill Fabrocini, has helped many athletes recover from serious injuries. However, perhaps no athlete has made a more remarkable recovery than snowboarder, Chris Klug, who was close to death before he received a liver transplant. Klug recalls, "I was in the 11th hour of the transplant waiting process. When I got to that 11th hour, though, I started to lose hope."

Though Klug was fortunate to get the life-saving organ, he was physically devastated from the long wait and the surgery itself. After the operation, Fabrocini took over. He shared with me his thoughts about helping Klug, and others with serious injuries, recover. Fabrocini explains, "I did a lot of working around the injury-all of the other segments of his body. I got him to think about all of the uninjured areas, and to start to focus on the areas of his body that were working positively-that were uninjured. Then, I connect all of those areas together so that the body starts to work again as a "whole." This is what breeds confidence." One and a half years after his transplant, Klug became an Olympic snowboarding champion.

So the first step in healing from a serious injury or illness is to start using whatever parts of your body are uninjured or the least injured. Most cancer survivors can begin by using their legs. Which leads us to Step 2.

Step 2 - Buy a pedometer and record how many steps you take each day.

Therapeutic exercise is designed to specifically combat the effects of serious illness or injury, which leave people weak and tired. For anyone who has been through cancer treatment, a major part of healing involves recovering from the "deconditioning" that occurs due to immobility and sometimes bed rest. One of the most striking effects of bed rest happens at the muscular level. Research has shown that people on bed rest lose 1-1.5% of their strength per day for the first two weeks. For those who have a limb in a cast, the rate of strength loss is higher-up to 5.5% per day. The total loss of strength can be as high as 25-40% in those individuals who are inactive for a period of two weeks or more. Marked losses in muscular strength occur even in those who are not on bed rest but who become sedentary due to a medical condition such as cancer. Losing strength in muscles occurs with no effort and happens extremely quickly. Gaining strength back takes considerable effort and occurs much more slowly.

Strengthening your body and working to build up your stamina will help reduce pain and fatigue and will almost certainly improve your mood. Although I always recommend that people check with their doctors before beginning to exercise, almost anyone (notable exceptions include those individuals with serious heart or lung problems) can safely begin this first step before they consult with their doctor. However, as you progress, be sure to check in with your physician.

So this step is to literally count your steps. I recommend buying a pedometer (these are inexpensive and can be found at most sporting goods stores and there are many online dealers). Obtain one that specifically counts the number of steps you take daily and record your steps for a week. What is the average number of steps you are taking?

Your 6-week goal should be 5000 steps per day. That means that wherever you start off, increase gradually by a few hundred steps per day in order to reach the 5000 mark. Once you reach the 5000 steps per day goal, then your next goal is 10,000 steps per day, and you can usually accomplish this over a period of 6-12 weeks. If you start out at around 5000, then your 6-week goal is 10,000 daily steps. Between 5000-10,000 steps per day is a good range for most people.

Using a pedometer is one way to increase your activity level and improve your overall conditioning and endurance. You'll start feeling much better as you are able to increase the number of daily steps you take.

Step 3 - Give up taking naps and sleep well at night.

Poor sleep, no matter what causes it, is detrimental to physical healing. Naps tend to interfere with good sleep at night and are usually better to skip once you are finished with cancer treatment--especially chemotherapy and radiation. At night, it may be hard to fall asleep or stay asleep due to worry or pain.

Insomnia, which is difficulty falling asleep or staying asleep, affects up to 50% or more of cancer patients. This condition almost always is part of a cluster that may include pain, fatigue, anxiety, and depression. Each of these medical problems, left untreated, has the potential to exacerbate the others. For example, poor sleep can contribute to a mood disturbance such as depression (think of women with post-partum depression who are sleep deprived-while there are also other factors that affect this condition, such as hormonal influences, lack of sleep is clearly an issue in this population) and someone who is depressed may have difficulty falling asleep or staying asleep because he is sad or worried.

It is important to note that pain is one of the primary causes of insomnia and appropriate intervention to treat pain can improve the physical symptoms of pain and fatigue as well as the emotional symptoms of depression and anxiety. On the other hand, attempts to treat pain can actually lead to or worsen symptoms of insomnia. For instance, opioids can cause daytime somnolence, which may interfere with sleep at night. Clearly this is a delicate balance and one which requires an experienced physician's input. If you are not getting at least 7-8 hours of quality sleep most nights, talk to your doctor about how you can improve your rest.

Step 4 - Pace yourself during the day.

One of my favorite quotes on the topic of pacing was written by Hugh Gregory Gallagher, a polio survivor who struggled with the debilitating after effects of this disease. Gallagher wrote, "My muscle power and endurance are as coins in my purse: I have only so many and they will buy only so much. I must live within my means, and to do this I have to economize: what do I want to buy and how can I buy it for the least possible cost?" Regardless of where you are in the healing process, you only have so many "coins." In order to optimally recover, you will need to use your muscle power and endurance wisely. Healing is not about pushing yourself to the limit without consideration for what tasks are important or how they will affect your body. Rather, healing well involves a thoughtful approach where you set goals and modify your activities to achieve those goals. While healing well does involve physically challenging your body to improve strength and endurance, it also involves periods of relaxation and rest. In short, in order to heal well you need to prioritize and pace.

Keep in mind that if you have a list of priorities and you refrain from doing the various things that are not meaningful to you, then you will maintain a good quality of life despite any physical limitations. Which means that more than likely you can do what you want to do as long as you avoid doing things that aren't all that important.

Thinking about this another way: now is your chance to unload all of the boring, mundane, and monotonous tasks that you never enjoyed doing anyway. Regardless of whether you decide to hire people and use various services to decrease your "to do" list, this is a good time to let friends know how they can help. You certainly can do this in a very considerate way that will not overly burden those you are close to. For example, ask a friend to take your clothes to the dry cleaners when she takes her own. Or, inquire when your friend is next going shopping and ask whether he could pick up a short list of items for you at the same time. Finally, there are plenty of things that you probably did in the past which simply don't need to be done at all or at least in the same way.

The suggestions I have thus far made are just that-suggestions. In order for you to have a good quality of life and optimize your ability to heal, you will have to decide for yourself what tasks are most important to you and how you can best accomplish them.

As you focus on healing from cancer and its treatments consider incorporating these four steps into your plan. They'll help you to heal faster, better and stronger.

Author:

Julie Silver, MD is a breast cancer survivor and the author of the newly released book, After Cancer Treatment: Heal Faster, Better, Stronger (Johns Hopkins University Press), available in bookstores and through Amazon.com. She is an assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. Dr. Silver is also the founder and director of RESTORE, a multi-disciplinary program that focuses on physical recovery after cancer treatment. Dr. Silver is a recipient of the 2006 Lane Adams Quality of Life Award, the most prestigious honor given to caregivers by the American Cancer Society.