Wanda Wade is tired this Thursday afternoon, and understandably so.
For the first time since her breast cancer surgery a month ago, she's back at work, taking calls and greeting patients at a local medical office during the day, before cleaning at a veterinary hospital in the evening.
She's also getting a workout.
Aaron Knutson, a certified cancer exercise specialist at Spectrum Rehabilitation and Wellness Center, has already guided her to an upper-arm bike and a treadmill, stopping her every few minutes at each machine to clamp a small pulse oximeter to her finger.
"Excellent!" he exclaims after the device shows barely a reduction in Wade's blood-oxygen level. "Amazing!"
Throughout her visit, Wade wears the expressionless, cautious look of someone trying to ignore pain, but Knutson maintains his peppiness as he introduces Wade to the TurboSonic vibrating platform. The machine looks innocuous, like a mini-trampoline with a video game console attached.
Knutson, speaking in a studied and soothing tone, explains how movement from the machine will strengthen Wade's whole body.
His words contrast with the sharp vibrations from the machine that follow. Wade's body bounces like she's sitting on an imbalanced clothes-washer, and Knutson jokes with her as a distraction: "Is your nose running? Are your ears itching?"
Wade, two days after getting the first dose of harsh chemicals that should kill any cancer cells left in her body, cracks a small joke in response.
"I could do this for belly dancing," the 54-year-old says, her voice barely more than a whisper.
New way of thinking
Treadmills and TurboSonic machines are not the first things that come to mind when you think of recovering from cancer. Carole Schneider, an exercise researcher at the University of Northern Colorado in Greeley and a pioneer in the field of cancer rehabilitation, says the conventional wisdom when she was treated for cancer 13 years ago was far different.
"It used to be believed, if you exercise, it would spread the cancer cells," she says.
The conventional wisdom has started to change, at least in theory.
In Colorado Springs, Memorial Hospital and Penrose-St. Francis both started cancer rehabilitation programs within the past couple years. Spectrum Wellness, a personal training and physical therapy center, started offering its own cancer rehab program last year with Schneider as a consultant.
Schneider, a UNC professor with a Ph.D. in exercise physiology, has written extensively about the effects of exercise on cancer recovery. She describes her relationship with Spectrum as a sort of experiment as well. While many cancer specialists agree the right amount of exercise can benefit their patients, she says, the struggle in making cancer rehabilitation programs available is getting businesses started that can make a profit by offering them.
"In order to get this going, we have to show that it's billable, [and] here's the process," she says. "It's very important to have a for-profit model that can be shown to other places."
David Gerstel, a licensed physical therapist and Spectrum's owner, moved to Colorado Springs in 1997, and later that year his dad, living back in South Carolina, was diagnosed with cancer of his bile duct and pancreas.
Doctors tried a form of radiation therapy, and over the next eight months the family watched as he wasted away, looking at the end like "someone from Auschwitz," Gerstel says.
The family members asked what they could do, he says, but were told there was basically nothing.
"All [the doctors] could do is treat the cancer," he says.
At the time, cancer rehabilitation was not an option, and Gerstel now has no illusions about what effect it might have had.
"Would it have saved him?" he asks. "No. Would it possibly have elongated his life? Yes. ... Would it have improved the quality of his life? One hundred percent."
Gerstel and his family started the Gerstel Cancer Foundation in 2002. In 2005, he opened Spectrum, a physical therapy practice, with the goal of using funds from the foundation to help support cancer rehabilitation.
Building the program
Jeff Hegewald, Spectrum's first cancer patient, went through the program last fall.
Spectrum's cancer rehab program is expanding slowly, now involving Wade and five other patients. Gerstel says insurance companies will pay for the services, so it can work as a business.
Bigger obstacles in his view are limited access to cancer rehab services and lack of knowledge that it works.
"I think most people are unaware this is something that can help them," he says.
Cancer treatment can take weeks, months or even years. At the severe end, a patient might endure 18 months of chemotherapy. Without any exercise for that whole time, Gerstel suggests, a patient will lose a huge amount of muscle and suffer from a weakened immune system, possibly compounding feelings of depression and preventing a person from working or enjoying life.
But exercise also can be risky for cancer patients. Cyclist Lance Armstrong famously bounced back from testicular cancer to win the grueling Tour de France seven consecutive times.
Trying to follow Armstrong's example could be dangerous. Gerstel cautions that cancer patients who train too hard can risk weakening their immune systems or disrupting their other treatment.
A pulse oximeter is one tool of the cancer rehabilitation trade. By monitoring a patient's pulse, blood pressure and blood oxygenation level, and combining those numbers with knowledge of cancer drugs and attention to a patient's energy level, a therapist can keep a cancer survivor going on the narrow path between too little and too much exertion.
"It's knowing how to progress properly," Gerstel says.
In March 2007, Jeff Hegewald was preparing his high school students in McAllen, Texas, for their upcoming AP exam in world history when he started getting severe stomach pains. It was his second year as a Teach for America volunteer, and doctors at first chalked up the pain to an ulcer, appendicitis and other possible ailments.
He describes the pain as something out of a horror movie: "It felt like something was in me trying to dig itself out."
After three weeks during which he could barely eat, doctors found a tumor in Hegewald's intestine. It was later diagnosed as Burkitt lymphoma, an aggressive form of cancer that starts with the cells from the immune system. Within days, he received his first weeklong round of chemotherapy. He came back to Colorado Springs and started a treatment routine that continued nearly six months.
The pattern was basically a three-week cycle. For five days, he was stuck in a hospital with a continuous stream of chemicals flushed through his body. He got out, and only felt capable of being active just before his next round of chemo was to begin.
Hegewald is a soccer player, but over the months his muscles disappeared. He dropped from 150 pounds to 112 pounds. In October 2007, just as he was approaching his 25th birthday, Hegewald finished his treatment and found himself "bald and pale," with no muscles or energy to develop them.
A life turnaround
Physical therapy is standard for people who've had heart attacks or their knees operated on. Hegewald, a Cheyenne Mountain High School graduate, asked his doctor if she could write a prescription for him to do likewise to recover from his chemotherapy.
Insurance paid for rehabilitation sessions at Spectrum over about three months. By November, Hegewald was able to start substitute teaching again. In six weeks, he could run again, and in March he received a grant from the CancerClimber Association to join a group hiking Peru's rugged Inca Trail to Machu Picchu.
Less than a year after his cancer was diagnosed, and less than five months after finishing chemotherapy, Hegewald completed the arduous four-day hike over high mountain passes.
"I was able to do something healthy people struggle with," he says.
When Hegewald was diagnosed with cancer, he was forced to defer his plans to begin law school the next fall at the University of Miami.
This week, he's moving to Miami to continue with that plan.
Starting the battle
Wanda Wade's at a different point in her struggle with cancer. She's had one round of chemotherapy and expects the treatment to go on for four or five months, with radiation to follow.
While doctors eliminated Hegewald's tumor with chemicals alone, Wade had a lumpectomy, or partial breast removal, and several lymph nodes were removed. The latter surgery has left her with a painful scar in her left armpit that makes it difficult to raise her arm.
On Thursday, Wade looks exhausted as she arrives at Spectrum, still wearing her name tag after her first day returning to her job as a medical receptionist. She moves slowly when a therapist invites her back to work on her arm.
Two weeks ago, she could barely move it. Today, the therapist manages to coax it over her head, asking Wade to rate the pain she's feeling on a 10-point scale.
"I'm about two or three," she says.
Aaron Knutson greets Wade as she finishes her shoulder work, asking her how she feels and if she's eating. "We just need calories," he says. "Find whatever tastes good."
Wade says the cancer "has thrown her for a loop," but she also seems to be handling it well.
Three years ago, she watched her mother go through the same thing. She got infections after chemo treatments. She still has trouble raising her arm.
Wade had her first session at Spectrum soon after surgery. Today, Knutson is keeping a particularly close eye on her.
"It's an easy day because we're two days out of chemo," he says. "I want to see how her body's reacting."
Things look good so far. Earlier, Wade explained she was feeling a bit depressed in the days before her chemo started, just waiting to get back to work and get on with her life. She does as much exercise as Knutson allows.
"I'm not a sit-around person," she says, explaining she wants to be out and about whatever the effects of the chemo drugs. She tells one of the therapists: "I've got some cute wigs and scarves picked out."