How Being a Runner Helped Me Stride Through Lung Cancer Surgery

This article originally appeared on Outside

I have been a competitive runner for more than 70 years and, as more years go by, I keep finding more good reasons to keep running. The latest, totally unexpected, is that it puts you in peak shape for surgery.

Not your problem? You're 100 percent healthy? Symptom free? Regular medical checks showing all clear? Super-fit for running? So was I.

The simple reality is that serious medical problems, and in some cases surgery, are an increasing hazard as you move through your sixties, seventies, and eighties. We are, it seems, mortal, although I don’t recall ever agreeing to that arrangement. In my case, the out-of-the-blue diagnosis was the early detection of lung cancer.

I'm not writing to make a drama from that all-too-common experience, which was, in my case, skillfully and successfully dealt with. I want to pass on the main lesson I learned from the last six months: that being a runner in good shape made the whole process smoother, safer, faster, and less damaging long-term.

Full disclosure: I have no medical qualifications, nor special knowledge other than as a thoughtful lifelong runner. The remarks that follow are my personal conclusions from my personal experience. The only medical recommendation I offer is that running is good for you, in general, and in case you ever need to undergo surgery.

The better shape the body is in, the less serious and traumatic the experience will probably be. My running fitness was evident and appreciated before, during, and after the surgery.

BEFORE

When they measured my lung performance pre-surgery, I tested 153 percent for my age (that’s a simplified version of the results).

My doctors told me, "Even though lung lobe removal is the most effective treatment, we often can’t undertake that significant surgery at your age (then 83), because the reduction in capacity would not leave sufficient to cope with the demands of normal life."

In other words, thanks to my runner’s lungs (big, capacious, efficient), I had an adequate margin to lose some capacity and still function comfortably through life afterward. They kindly warned me that my running would be adversely affected, but I’d figured that out for myself.

My heart, too, gave enthusiastic proof that it had ample resilience to deal with the general anaesthetic and whatever else I might have to undergo. I generally break age records on health clinics’ treadmill tests. Resting pulse is low, the heart copes robustly with effort, it can hold high heart-rate levels without problem, and it recovers and returns to normal quickly and smoothly--all good signals for problem-free surgery, and not as common as we might think. My procedure got bumped by 24 hours because the patient before me had a cardiac incident on the operating table. My guess is that a lifetime of interval repeats made that less than likely for me.

Preparing mentally for the surgery was also helped by being accustomed to getting mentally ready to race. In the days before the operation, I told myself that this was easier than any race--all I had to do was go to sleep. I wasn’t the one who had to perform at a top level or have my ability tested. Nevertheless, it felt like a test, a challenge, and I was aware that I was approaching it with that curious mix of nervousness, determination, and off-to-the-office relaxation that is typical before a race.

DURING

Invasive surgery and removal of part of the body is serious stuff. General anaesthetic itself is a traumatic shock to the body. Yet despite my advanced age, I came through without any apparent problem. That is probably because a lifetime of hard racing and training has accustomed my system to deal with extreme physical stress. Runners’ bodies learn how to manage discomfort, even pain. That’s not usual in our cosseted modern world, which inflicts stress on the mind more often than on the body. My guess is that from my body’s point of view, the impact of surgery was probably not unlike the impact of a serious interval session--something to be tolerated, endured, recovered from, and adapted to. The main difference between hard running and being carved up was that the latter happened lying down while I was unconscious. And there was free oxygen available.

My runner's leanness also paid off by simplifying the process of incision. When my family physician checked the scar, she said it was the smallest she had ever seen for the lobectomy procedure, and attributed that to the fact that there was no body fat to be cut through and held in place. That made it possible for the surgeon to work without cutting muscles, leaving me without the usual damage to my shoulder and arm movement.

The only problem about being a post-surgery runner was revealed in hospital in the darkest hours of night. My low heart rate put on a nightly comedy show. My resting pulse is in the high 40s, and it apparently drops to low- to mid-30s at the time of deepest sleep. That’s no worry for me, and it’s normal for a well-trained runner, but it’s below the official safety level of 40 beats per minute, and therefore a source of alarm and anxiety for the nice night nurse.

I figured that she does her rounds every four hours, taking blood pressure and checking vital signs. To save her worrying about me, and spoiling her well-earned rest, I learned to recognize the sounds as she crept stealthily from bed to bed, and I spotted the moving glimmer of her little flashlight. When she was one patient away, I would start secretly pumping my legs in bicycle pedal movements hidden under the blankets, watching the dial above my head creep up. 32--pedal pedal--36--pump pump--39--pedal pedal pump--42--over the line! By the time she reached me, my heart was at a reassuring 48 or 50 per minute, probably beginning to think I was off for an early run. The nice night nurse documented my stats, and continued on her rounds happy that all was well.

Thus, I conformed with what the modern world considers normal. I am grateful for the nurses' care to ensure I came safely through the night. But I wonder what the average Neolithic person’s normal resting pulse was?

AFTER

Runners practice how to recover, over and over again. It’s something we are very good at. We know how to rest, but also, given the choice between total rest and a cautious measure of activity, we know that low-level movement will usually bring the best recovery.

I was ready to walk pretty much as soon as the drainage tubes were disconnected. It was a great treat when I had to go for an x-ray and they didn’t have a wheelchair free, so I hiked under escort along a maze of underground passages. They let me go home after only three nights.

The booklet they provided on "Lung Surgery: Home Management Guidelines" was helpful, but it again revealed the gap between runners and what is "normal." It advocated exercise, with caution initially followed by a slow increase. All good, except that the recommended exercise levels would not be worth a runner changing socks for. At the end of Week 1, the book's recommended level was five minutes easy walk, three times day; I was walking more than an hour without any strain.

After two weeks, I introduced a little slow running--literally one minute, then two minutes two days later. By such small steps, every second day, I have moved from 8 x 2 minutes in Week 3, to 10 x 3 minutes in Week 5, and up to 4 x 10 minutes in Week 7, with the walk recovery interval also slowly diminishing.

Runners are often told, "Listen to your body." I totally agree. But I also expect my body to listen to me. It’s the age-old training principle of progress by small stages of overload and adaptation. As I walk or jog on my new lower-cylinder engine, I judge the point where I am slightly pushing the breathing, teaching the reduced lungs something new. The body willingly adapts, but only if you show it what it needs to do. I literally listen to my body. If I do too much, it makes noises like the character I used to read to my children, Thomas the Tank Engine.

There is double evidence of progress. I can chart it from the movement in my Thomas the Tank Engine limit, and the hospital’s six-week x-ray also showed that the gap in the lungs is already being filled.

Will I ever get back to the racing level I was at before the surgery? Almost certainly not. Will I get to a level where I can be competitive enough to satisfy me? Probably, but not for many months, and after that who knows? I’m willing to try. The benefits of running are too great to stop. And there's a lot to discover about running on reduced lung capacity.

POSTSCRIPT

At our six-week sign-off consultation, the surgeon told me, "Lead your normal life." I whispered to my wife, "He has no idea!" A few days later, less than seven weeks after the surgery, I registered for a 10K, initially only to make up a team, and anticipated walking much of it. But I unexpectedly found myself able to hold a pace just below stressing the breathing. I guess an experienced runner is good at finding that level. And so I ended by running the whole 10K, months before I expected that to be possible, in 61:38. Not bad, though not close to my best recent time pre-surgery, 52:49.

Two weeks later, after doing some repeat 400s to work the breathing, I tried a 5K. Again, bad and good news: 29:59 was five minutes slower than I could run before the surgery, yet five minutes faster than I thought would be possible at this time.

Always another challenge. I’m realistic about the gap, but hopeful that I can close some of it. I’ll have fun trying, and I’ll be healthier for the effort.

Roger Robinson is a leading writer and historian of running, and lifetime elite runner. He won the world cross-country championship in his 80-84 age-group in February. His latest book is Running Throughout Time: the Greatest Running Stories Ever Told (Meyer & Meyer).

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