Yoga Journal - December 2004

When Connie Hawley learned that she had an aggressive and advanced form of non-Hodgkin's lymphoma she vowed to fight. "I developed a war mentality," says Hawley, who was a 31-year-old speech pathologist in Kalamazoo, Michigan, at the time of her 1993 diagnosis. "I steeled myself for a battle to beat this cancer."

But after six months of aggressive chemotherapy, which left her headachy, weak and nauseaus, a weary Hawley declared a truce. "I was totally exhausted, both from the treatments and the fighting," she says. "The cancer was getting worse, I felt awful and depressed." One morning when she had barely enough energy to brush her teeth, Hawley lay on the floor and started doing some breathing and gentle stretches she remembered from a yoga class she'd taken several years earlier.

"Little by little a voice came through encouraging me to make peace with my body and appreciate the things that were okay," recalls Hawley, who continued her gentle yoga practice through two years of chemotherapy. "Yoga helped me come into a nurturing energy, to befriend my body, listen to it and treat myself with gentleness and compassion."

During long hours in doctor's offices and treatment rooms, Hawley would place a hand on her belly, close her eyes and do pranayama (breath work), such as breathing deeply into her diaphragm or extending her exhalations. When a CAT scan technician asked her to take a deep breath, she'd inhale slowly through her nose and visualize all the sacs in her lungs opening to accept prana (vital energy). In August of 1995, her doctors told her she was in total remission.

"Yoga is an incredible tool for accessing the body's amazing capacity to heal itself," says Hawley, who still undergoes annual tests to monitor for relapse or recurrence. Drawn to share yoga's gifts, she completed a teacher training program at Kripalu Center for Yoga & Health in Massachusetts. Now living in Houghton, Michigan, she offers yoga classes as a wellness tool and has worked with people who have serious illness. Her oncologist also has become interested in using yoga to help his patients. "Yoga may not cure people with cancer," Hawley says, "but it can certainly help them heal."

One of America's nearly 10 million cancer survivors, Hawley is part of a growing movement to harness yoga's healing power to help people with cancer cope with treatments, relieve troublesome symptoms and reclaim their lives. Although cancer was once considered a death sentence, many types of it are increasingly being viewed as chronic conditions not unlike heart disease or diabetes. Advances in diagnosis and treatment means that, even when a cure isn't possible, long-term survival often is, notes Julia Rowland, Ph.D., director of the National Cancer Institute's new office of cancer survivorship. "One of the hot research areas right now is how physical activity may benefit cancer patients," she says. "We know it can improve quality of life, and there's some suggestion that it can alter disease outcomes and perhaps improve survival." Yoga is a form of activity many physicians are comfortable with, Rowland notes, since it's seen as a gentle way to restore range of motion after surgery, relieve tension during treatments and bring a sense of calm and well-being to people whose worlds have been turned upside down by the disease.

Breathing-It's Right Under Your Nose

Many aspects of yoga practice are helpful for patients dealing with the physical and emotional toll of cancer treatments. For example, moving through yoga postures can help restore physical function and enhance mood. But many cancer survivors and yoga teachers say the single most important practice can be pranayama (breath work), which can relax the body, still the mind, and help people connect with their spirit.

"Using the breath as a tool to release tension and anxiety is unknown to many people," says Faith Isaacs, a therapist and yoga teacher who in 2002 helped establish a yoga program for cancer patients at Valley Hope Hospital's Center for Complementary Therapy in Ridgewood, New Jersey. "When you walk into the chemotherapy room you can feel how strained and anxious people are, with many of them holding their breath." One of the reason's for pranayama's effectiveness is its sheer adaptability: Breathing practices can be done anywhere, anytime--in hospital beds, in treatment rooms, and during long, anxious periods of waiting for test results, doctor's appointments and surgical procedures-by people in all stages of illness or health.

Simply learning how to take a deep, full breath can be extremely therapeutic in many situations, Isaacs says. Deep belly breathing calms both body and mind, she notes, "and it's easy to learn, it doesn't cost anything, you don't need an outfit, and you take it wherever you go." In addition to relaxing "wired" people and energizing tired people, Isaacs adds, "breathing techniques give patients a sense of being able to take part in their treatment. Cancer patients are so used to having things done to them and for them all the time, so it's very empowering to have something they can do for themselves."

Deep diaphragmatic breathing also helps rid the body of gaseous chemicals and can bring as much as seven times more oxygen into the lungs as shallow breathing, says Jnani Chapman, a registered nurse and certified massage therapist who runs the clinical yoga programs at the Osher Center for Integrative Medicine at the University of California, San Francisco (UCSF) and the Ida & Joseph Friend Cancer Resource Center at UCSF.

The best breathing practices for cancer patients are the simplest ones, says Chapman, who recommends deep belly breathing and extended exhalation [see sidebar below]. "This is not the time for anything complicated or for breath retention," she says. "Too many people have been holding their breath all their lives."

Pranayama coupled with visualization helped 52-year-old Pauline Fray through a year's hospitalization nearly four years ago for treatment of acute myeloid leukemia. "I used belly breathing a lot of the time to calm my mind and body, particularly during a lengthy process such as having a femoral line inserted, which could take two hours," recalls Fray, a yoga teacher in Surrey, England, whose fingernails, toenails and hair fell out several times as a result of treatments. "To try to get to sleep at night I would use alternate-nostril breathing. And if I was running a temperature, I'd use Cooling Breath pranayama." Fray often accompanied her breathing practices with imagery. "Each day I would use my breathing to calm my mind, and be able to visualize my blood cells as healthy, plump and gorgeous," she recalls. Now, having regained most of her mobility and flexibility-as well as new bone marrow (her own, cleaned and recycled)-Fray says, "what I learned was that, having been hit by the necessary 'club hammer' of Western medicine to save my life, I needed complementary therapies like yoga to regain my health."

Meditation: The Benefit of Silence

In addition to working with the breath, many cancer patients find that meditation is a powerful yogic tool. "When people meditate, their true nature shines through, reminding them who they are," says Nischala Joy Devi, a yoga teacher in California who created one of the country's first yoga programs for people with cancer in 1982 as part of the Commonweal Cancer Help Program in Bolinas, California. "They are not their cancer, and they are not just their bodies. They are divine beings."

Meditation gives people a sense of hope and optimism that can stimulate the immune system, Devi says. "Twenty years ago people told us it was ridiculous to think that something like yoga could have any effect at all on a something as strong as cancer. But today there's a greater appreciation for the power of the mind to heal and a recognition that thoughts and feelings can trigger cells on a physiologic level."

When combines with the yogic principle of ahimsa (non-harming), meditation aids in harnessing this therapeutic effect. "How we view the cancer, the treatments and ourselves is very important to healing," Devi says, adding that chemotherapy is typically considered a poison that kills cancer cells. "Taking a poison is a frightening concept," she notes. "The more we talk about something as negative, the more our body sets itself up to reject it." Instead, Devi advises patients to adopt an attitude of ahimsa and meditate on chemotherapy as "a nectar that helps the body rid itself of what it doesn't want. This can help people heal, and not be so adversely affected by side effects."

Ahimsa also teaches people to treat their bodies with love, which can be extremely therapeutic for patients who feel betrayed or repulsed by affected body parts. "I encourage people to touch their scars and say nice things to a breast that has been removed, because energetically it's still there," Devi says. "Yoga reminds people that--regardless of whatever's been cut out or scarred--on a subtle level, they are still whole." These practices help people let go of fear and tension, which can block the flow of prana (vital energy) and result in pain. "When you allow prana to flow, the reduction in pain can be quite dramatic," Devi explains.

After being diagnosed with breast cancer in May 2003, Betsy Flagg created a ritual that incorporated the most meaningful aspects of her yoga practice. "In the waiting room, I sit in sukasana (easy, cross-legged pose) and listen to Sanskrit chanting by artists such as Krishna Das, Shakti Fusion of Deva Premal," says Flagg, 51, who works at IBM in Research Triangle Park, N.C., and has been practicing yoga for nearly a decade. Since her Walkman isn't allowed in the radiation therapy room, she brings earplugs to protect her ears from the noisy equipment and to help encourage pratyahara (sense withdrawal), which deepens her meditation. "I bless my breast, the radiation machine, the room and all who enter," Flagg says. She does a variety of breathing practices, including ujayi (victorious breath) and viloma (interval breathing) while meditating on being bathed in healing light.

The yogic principle of isvara pranidhana (devotion) is central to her practice of Anusara Yoga. "I didn't choose the disease, but I can choose my attitude," Flagg says. "I trust that the Divine has my best interests at the forefront. Grace abounds. My job is to be as fully present as I can be and accepting of whatever life serves up." Among the most powerful lessons of this experience, she says, "is you can go through trauma and still find beauty."

Asana: Befriending the Body

In the best of times, asana (the physical poses) practice allows us to reconnect with our bodies. But for those dealing with cancer treatments, doing yoga postures takes on another layer of importance. "With cancer, it's common to feel like your body has betrayed you," says Lisa Holtby, who taught twice-weekly classes for clients of the Seattle agency Cancer Lifeline for two years. "A regular asana practice can help students experience their bodies as capable and reliable once again." After surgery, chemotherapy or radiation therapy, appropriately-modified postures can help realign scar tissue's collagen strands and regain lost strength and flexibility, says Holtby, who required students to seek advice from their physicians about any specific precautions for their practice.

In contrast to her typical classes, which begin standing, Holtby began her Cancer Lifeline classes with participants reclining in restorative poses. "I tried to hold the space for my students to simply be where they were, so they felt supported to cry or be in a bad mood or just rest," says Holtby, who offers four sequences of adapted asanas in her new book, "Healing Yoga for People Living with Cancer," (Taylor Trade Publishing, 2004). Although she recommends that women who have recently had mastectomies avoid certain postures, such as Downward-Facing Dog Pose, she generally encourages a wide array of poses. "In my experience, it is the challenging stuff that gets these students going," Holtby says. Backbends, in particular, are mood brighteners and help relieve depression. And, for those who are ready, supported inversions help shift perspective.

"I remember setting up a headstand for a gal in her 50s who had never done the pose before," says Holtby, who used extensive props and spotters to help this breast cancer survivor into a modified headstand. "It was incredible to see her experience herself as powerful and able to change and grow," she recalls. "The body is a powerful vehicle for the spirit, and the practice itself becomes a prayer."

Asana practice also helps relieve joint and muscle aches that can be a side-effect of medications, says Maureen Wolfson, 58, a retired financial services executive who was diagnosed with breast cancer in 2003 and had surgery, chemotherapy and radiation treatments. "I was often very sore and achy from the drugs I was taking and found the yoga class really helped me relax physically and get calm mentally," says Wolfson, who took Faith Isaacs' yoga class at Valley Hospital's Center for Complementary Therapy in Ridgewood, New Jersey. "No matter how awful I felt going to class-and sometimes I had to drag myself there-I always went because I knew I would feel so much better afterwards."

It's common for patients to come to class even when they know they can't really do much, says Lynne Jaffe, who since 1997 has taught a yoga class for cancer patients at the Cornucopia House Cancer Support Center in Chapel Hill, North Carolina. "The camaraderie alone can be healing, and many people say they find the relaxation that's woven into the class to be very beneficial." Jaffe is careful to avoid head-below-the-heart poses, which can be difficult for people who have nausea. "Sometimes the best thing to do when people are uncomfortable is to just prop them up with pillows in restorative mode and help them let go and relax," she says. Yoga practice can help redirect people's attention from their problems and help them focus on things they feel good about, Jaffe notes, "such as their heart and their spirit."

Living in Technicolor

Yoga's focus on connecting with the Divine can have a particular poignancy for cancer patients who tend to be very in touch with their own mortality. When people are diagnosed with cancer, "it's like Dorothy landing in Oz," Holtby says. "The intensity of living suddenly goes from black and white into Technicolor. I'm reminded by my students that our time here is so short and so bittersweet. The days race by, but every moment is ephemeral and precious. That's why we get on our mats in the first place. To call ourselves to be present."

It's important that yoga teachers encourage students who have cancer, but they should avoid making promises, Nischala Joy Devi cautions. "Not everyone is cured of cancer," she says. "Some are helped to die. What yoga can do is help people enjoy their life for as long as they're here."

Facing mortality often prompts healthy life changes, says Sudha Carolyn Lundeen, who was a 35-year-old nurse at New England Medical Center in 1984 when she was first diagnosed with breast cancer. "Cancer was the kick in my butt that made me stop in my tracks and ask, 'What am I living for?' 'What is my life about?'" recalls Lundeen, who had taken a weekly yoga class for several years before her diagnosis. She had a lumpectomy, after which she decided to go to Kripalu for three months to immerse herself in a healthy lifestyle. There she learned what she calls the "big Y" yoga, which is not just asana (postures), but an entire way of life.

"Yoga philosophy spoke directly to my experience," she says. "For example, satya, (truth telling) helped me recognize that 'Yes, I have cancer, and in this very moment most likely I am fine.'" The support and compassion she experienced at Kripalu convinced her to extend her three-month stay to 10 years, and she became of the center's most popular teachers.

In 1994, Lundeen's breast cancer recurred, and she had surgery and radiation. "My experience with cancer has been a gift," says Lundeen, citing a favorite quote from author Wayne Muller: Knowing I will die, how then shall I live? She explains that "cancer has been the hardest but most potent vehicle for change in my life. And yoga has given me some hefty tools to help wake up and live a life that has more meaning and more joy."

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SIDEBAR: THE HEALING POWER OF THE BREATH

One of the most helpful yoga practices for cancer patients undergoing harsh treatments is pranayama (breath work). Jnani Chapman, a registered nurse and certified massage therapist who runs the clinical yoga programs at the Ida and Joseph Friend Cancer Resource Center and the Osher Center for Integrative Medicine, both at the University of California, San Francisco, offers these instructions for an effective breathing practice.

Rising and Falling Breath

Benefits: Strengthens the nervous system and calms anxiety.

How to Do It: Lie on your back with your hands resting on your abdomen. Tune in to your breath. On the inhalation, consciously expand your belly as if you were inflating a balloon. Let your breath continue rising up through your rib cage and out to the sides; you should feel the top of your lungs inflate and your collarbones rise. Begin your exhalation at the top of the lungs, so that as you release air there, your collarbones lower. As the exhalation continues-with the ribs contracting in and down-draw your abdominal muscles in and bring your belly button toward your spine. Let your exhalation be long and slow. If you are counting, try to exhale for longer than you inhale for each breath. While you breathe, keep your torso completely relaxed. Don't let the muscles in your rib cage tense or tighten as they move; simply let them expand and contract with each breath.