Moving Through Bladder Cancer: How Physical, Mental and Emotional “Exercise” Impacts your Treatment and Mental Health.

January 20, 2023

With Dr. Matt Mossanen and Patient Advocates, Scott Eriksson and Mark Block

Year: 2023

You can read the full transcript of How Physical, Mental and Emotional “Exercise” Impacts your Bladder Cancer Treatment and Mental Health below

Part 1: The Medical Importance of Exercise with a Bladder Cancer Diagnosis

Video (5 min) | Transcript (PDF)

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Part 2: Adding Exercise into Your Daily Routine with Bladder Cancer

Video (14 min) | Transcript (PDF)

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Part 3: Mental “Exercise” to Impact to Improve Your Mental Health

Video (15 min) | Transcript (PDF)

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Part 4: Question and Answer about Exercise for Bladder Cancer

Video (20 min) | Transcript (PDF)

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Full Transcript of How Physical, Mental and Emotional “Exercise” Impacts your Treatment and Mental Health with Bladder Cancer:

Stephanie Chisolm:

Welcome to Moving through Bladder Cancer: How Physical, Mental and Emotional Exercise Impacts your Treatment and your Mental Health. BCAN would like to thank Scott and Mark’s company’s NERDbody and Bluerisa for donating their time to do this program for you. This program is occurring in early January and many people traditionally have made New Year’s resolutions to get back into physical exercise this time of year.

We know that staying active during and after bladder cancer treatment can really impact a patient’s quality of life as well as their outcomes for treatment. BCAN is delighted to welcome Massachusetts General Hospital, Brigham and Women’s Hospital urologist, Dr. Matt Mossanen. He is here and joined by patient advocate, Scott Eriksson and exercise professional, Mark Block for today’s program.

They’re going to share why it’s important to be physically fit during treatment and they’re going to give you some tips on how to incorporate more movement into your everyday life. It doesn’t mean you have to go to the gym. It doesn’t mean you have to set aside huge blocks of time. I think that they both have some very good tips for how you can fit exercise into your day.

So I think this is exciting. I would really like to turn this over right now to our speakers. So Dr. Mossanen, if you want to take it away. I’m going to fade into the background and then Scott and Mark will put your slides up right afterwards.

Dr. Mossanen:

Thank you very much Stephanie and Morgan and BCAN for this wonderful opportunity. This is very exciting to have the chance to talk a little bit about exercise and the importance of improving mental and physical health. I think my section of this talk, and I’m eager to hear the other two speakers, is going to be mostly on what the surgeon’s perspective might be. I think a healthier patient that’s able to get a little bit more exercise and improve fitness has countless benefits for their general health, their overall wellbeing, and I think that’s going to be discussed well.

But I think what I wanted to do is just take a moment to maybe highlight some of the surgical reasons why it might be good to improve health. We’re talking about physical health and of course the psychological benefits of exercise and activity as well. A new bladder cancer diagnosis is obviously something that can be very stressful.

So first and foremost, being able to be active is an opportunity to be an outlet for patients that might be facing a diagnosis for the first time and juggling multiple possible treatment options. Another reason why I think exercise is important is because once a patient does undergo treatment, a patient with good fitness might be able to tolerate that treatment better.

One of the most relevant examples I think is for patients undergoing a major operation like a radical cystectomy with a urinary diversion. A healthier patient that is more active prior to surgery might have a better recovery afterwards. So a lot of surgeons are thinking about things like rehabilitation or exercise and activity and diet and mental health recommendations before surgery to improve a patient’s fitness so that when they do undergo a major recovery like after a cystectomy which can take several months, then they’re better able to recover.

And if they have a complication or problem after surgery, then a healthier patient might be better able to withstand that complication. So it’s clear everyone in this room thinks that exercise is great and surgeons love it. We love when patients say I exercise multiple times per week. But I think the challenge and what I’m hoping I’m going to be learning along with everyone else here is what are some pragmatic ways to help patients become more active, to improve their fitness, to have better mental and physical health so that not only are they better able to tolerate whatever bladder cancer treatment they receive, but to also just be healthier in general and to have better wellbeing.

So those are my two cents on that and I’m looking forward to moving to the next part of the talk and hearing the other two speakers and all of their insights. So I’m going to pass it along and move into the background as well.

Scott Eriksson:

I’m going to talk about ways that you can integrate exercise into your life. My background, I’m a nerd. I’ve been a nerd for 35 years. I still spend easily 10 hours a day at my computer, still write software. I was a pretty decent athlete way, way back in the day. In my mid to late 30s, I had a back operation. In my 40s, I gained a lot of weight and I realized I need to find a way to integrate a fitness lifestyle into my life, into my work life.

So little did I know in my late 40s as I started working on this that it was going to become super valuable for me in my 60., right before I turned 60, I was diagnosed with high grade bladder cancer. It was non-invasive. I had a golf ball size tumor in my bladder. Luckily for me it grew into the cavity and not through the wall. But I had to go through the resection and then the second resection and then I just had my last treatment, BCG treatment about two months ago.

So I’ve been through that journey in the last 18 months or so. But what’s interesting is during that time, I still stayed competitive in Masters Track and Field. That was something I picked up at 53 and started competing with a bunch of other older athletes like myself. And so in this time where I was going through the bladder cancer treatment and continuing to work at my software job, I was still fortunate enough to win five national track and field championships and two world championships in Finland this last summer. And then I set a couple American records along the way.

So I really didn’t do anything that taxing. As a matter of fact, as you see as we go through this, I’ll talk about my approach to it was really basically pretty simple. And again, it was something I started working on in my late 40s ’cause I realized I need to find a way to integrate fitness into my lifestyle. So we can go to the next slide. And really that’s the challenge. With all our demands of work and then treatment and really life in general, how do we get physically active enough? How do we maintain and increase our levels of fitness while we have all these other things that are calling for our time.

So if you go to the next slide, there are four things that takeaways that I want everybody here to have or at least categories or compartments to think about. One is this concept of something we call microburst workouts. The other is the recognition that life is the gym, right? Everywhere we go, it’s an opportunity to do something. Then how do we keep our momentum? Once we build it, this is that time of year where the gyms are packed and in a couple months the gyms will be pretty empty again.

So how do we keep that momentum and enthusiasm going? And so I have a couple tips there for everybody. And then some ways to get started on things. So if we can go to the next slide. So what is a microburst workout? If you look it up online, you’ll probably find different definitions, but for me, it’s a short one to two minute exercise that I can do throughout the day.

There’s a great quote, and this is a professor out of University of Houston. The one hour a day we spend in the gym does not immunize us for the other 23 sedentary hours of the day. So when I first read that, I really thought about it, it makes sense. Right at that time I was going through to the gym four or five times a week, an hour or two each time. And yet I still had excessive weight gain. I was going back operation and all that.

So I realized that wasn’t my answer. So once I heard that quote and I started doing some more research, this phrase kids, cats and cavemen came to me. Look at little kids. They get up, they run around, then they lay down for a while. They might get up a little bit later, run around, lay down for a while.

Look at cats. Some arguably the most athletic creatures on this planet. They’re sleeping most of the time, but when they get up, they move, they stretch, they jump, right? These are all little microburst workouts. And then through evolution, early on we were wired cavemen. We couldn’t go to the gym for an hour and lay around all day. The saber-toothed tiger would get us.

So I think just evolution wise, we’re wired for these short workouts to do throughout the day. Now, this is not an anti-gym concept. As a matter of fact, when we first launched this program a while back of getting a number of people to do these resistance and now use resistance bands… I’ll show you that in a bit here. To do these resistance band microburst workouts throughout the day, one of the really cool categories of feedback we got is that almost to a person, everybody had more energy than to go be active after work.

So again, really easy. Doesn’t need to be complicated. As a matter of fact, I don’t know, Stephanie, if you can open up that link there that says chicken wings and we’ll see if it plays a video. If it doesn’t, not a big deal.

Scott Eriksson:

And this is just an example of… And I’ll get into the little details a little bit more later, just by carrying a simple flat resistance band with you, you’d be amazed at the types of exercises you can do. And let’s be honest, as we get older, it’s not so much about building strength, it’s about maintaining mobility, flexibility and then finding ways and opportunities throughout the day.

All right. One of the best things we can do for our shoulders is chicken wings. We can do these throughout the whole day. Just grab your flat band about shoulder width apart, pinch your elbows into your side and rotate your hands to the outside. Go light enough so that you can really rotate out. And again, you can just adjust where your grip is on the band for resistance and you’re good. That’s chicken wings.

So as you see, simple, super simple. But especially if we sit down a lot all day, our shoulders get rounded. There’s other ones we do for our hips. There’s so many ways of doing things throughout our life where the life is a… So if we can go to the next slide.

There is a brand new one called Tomahawk Ab Crunchers. It’s going to seem a little complex, but once…

There you go. Thank you. We’ll wait for that next slide to come up. Okay. So what are some of the concepts of being able to do these exercises throughout the day? And so this is what works for me. And I went through a number of things from having free weights in my office to trying yoga in my office. And eventually it came back to the resistance bands. And so one, make it convenient. These things are so inexpensive.

I actually have resistance bands in my computer bag, in my office. I have them hanging on the stairs as I walk down from my home office down to the kitchen to get a cup of coffee or something. So there’s always opportunities to do a little stretch. And just by any movement that we do, add a little resistance and you’d be amazed at the difference it makes for you.

I send reminders to myself on the phone. So four times at Workday, I get a little reminder with a quote and just to get up and do it, to move. Grab my resistance band and move. And then here’s something that… And I don’t want to steal Mark’s thunder. We’re both masters athletes. For me, having something in the future that I’ve committed to, whether that’s going to a dance with my wife or having a track and field meet that I’m going to go to, having something I’ve committed to really helps me stay on point to say, “You know what? Yeah, I do need to do these exercises.”

So I think a little tip there. Committing to something that’s going to require you to be active in the future is a great way to keep motivated in the present. And then the last thing, and this is super, super important, try to identify the personal barriers to integrating fitness into your day. So for me, there were four. And so again, let’s go to the next slide. I like to do these at work.

So because I’m at work and I’m a self-professed workaholic, I love what I do. That’s why I spend so much time at my computer each day. So I don’t want to take a lot of time. I’m not going to go for a half hour walk, even a 15-minute walk. So I need these things to be short. That’s why I like the one to two minutes. I don’t want to get down on the floor to exercise. So with the resistance bands, there’s a lot of stuff you can do even for your core that you can do while you’re standing up or seated at your desk.

I don’t want to have to change clothes at work. Again, it’s time. And so you’re doing a one to two-minute activity. It’s an opportunity to get a little exercise in there. You can do it right in your work clothes. And lastly, I don’t want to sweat. Trust me, people who work with me, they don’t want me to sweat either. So those are my four personal barriers.So I had to be honest with myself. What keeps me from sustaining my fitness routine? And it was these four. Once I removed them, it became much easier.

So now remove the physical barriers, remove the things that keep you from working out. How do we maintain that enthusiasm? And so there are a couple tips or things that I’ve realized over time. One, we can’t act consistently in a way that’s inconsistent with how we see ourselves. And so I see it all the time. I’m sure Mark and Matt do as well. Trying to use negative self-talk as a motivator. “I’m too weak, I’m out of shape,” all that. That’s a tough way to go.

Praise yourself instead for the participating in the process. Yeah, I did four microbus workouts today or I went to the gym today. Right? Praise yourself for the process. It’s cliche if anybody’s been around exercise for a while, but it’s so true. And then lastly, we need to lighten up. I tell people all the time, if you stop, just restart. It’s as simple as that. And then consciously, if you can acknowledge your boost that you get when you get that feel good, you get the dopamine or the endorphins after our exercise, consciously acknowledge those. That’ll help you retain that feeling.

Some things that come up quite a bit. How long should you work out? Well, these are just a couple tips that I have that have worked for me for years. I always leave when I feel like I could do more. Keeps me wanting to come back. So especially when you get to a certain age, or especially if you’re going through treatments, exhaustion is not a good thing. As a matter of fact, when I was diagnosed I reached out to a doctor at a holistic practice in Arizona just to talk to him. And he told me working out was fine.

He said, “Don’t try to lose too much weight and don’t become oxygen deprived and don’t get exhausted.” So I thought that was pretty good advice. It also is good advice to keep us coming back to the gym or coming back to our workout. And then lastly, what about those days where we’re tired? Some of my best workouts have been where at the end of the day where I feel a little lethargic. On those days I might just be brain dead and body tired ’cause I haven’t done much. So the way I tell if I’m actually physically tired, need recovery or if it’s just low energy at the time that might pick up is if it does. Within a couple minutes of my warmup, if my energy picks up, that’s great. I was probably just a little lethargic. But if I’m still tired, then that’s my sign that I just… To stop and take a rest day.

So golden rule, and I’m sure others will agree with me on this, much easier to come back from a workout that was too light than it is from an injury or illness from overdoing it. I only bring this up because a lot of times when people haven’t exercised in a while, or even if they’re new, it’s so easy to overdo it because you don’t feel so sore when you’re working out. But the next couple days afterwards you will feel it. So much easier to come back from doing too little than doing too much.

And then getting started. Really, I’m going to reiterate some things here. Keep in mind it just takes a couple minutes. Right? Going to get that coffee, have that resistance band, do something with it. With the resistance bands, you can control the intensity. That’s great about them, right? It’s not unlike a freeway where it’s a set weight, where you start that resistance band, where you hold it, how fast you move it. You’re in control of how much resistance you have. Avoid the negative self. Image motivation, acknowledge the positive mood, and again, super, super important. Lighten up and have fun.

This is just an example of when I get these text reminders, here’s the types of exercises I have. It won’t mean much to anybody, but to sort of recap it, I focus on shoulder hip mobility in the morning. Then I might move this posture. There’s a lot of yoga moves in the mid-morning.

Afternoon, there might be some strength and the end of the day is more fun, aerobic type stuff, maybe a little bit. Some butterflies and bee stings for example is like a boxing move holding resistance bands. So you can see by the names here, I try to make it fun. It keeps you interested, and then you just do the one to two minutes throughout the day.

If you want to go next slide, this particular workout is up on a website called microburstworkout.com and BCAN is the password. So if anybody wants to go out there and look at that. I think there might be a typo here. I don’t think you need the wow at the end of it. So that’s my journey with having bladder cancer and exercising through cancer and the treatments and how to keep it fun and interesting and short. And also, how it coexisted with that treatment program that I had. So I thank everybody for the time. At this point I’ll turn it over to Mark.

Stephanie Chisolm:

That was awesome. And Scott, maybe what we’ll do is find out how we can get some pictures of you doing some of these different workouts that we can put into the transcript later on. Sure. So that’ll be really helpful to kind of show people what they look like. So Mark, take the way.

Mark Block:

Thank you so much Stephanie. And Scott, there are a few things that you talked about that I’m going to bring up today about setting goals and maintaining your vision. I am Mark Block. I am a certified personal trainer and coach. I’m also the creator and host of an online wellness program, bluerisa.com, which I focus and summarize as focusing on the crossroads of health and happiness. Now, we’ve been talking about exercise and exercise as Scott has proven, is great for relieving stress because a lot of what we go through in this journey through the diagnosis, through treatment, through surgery is the stress we’re under.

It’s interesting that exercise does lead to stress, but all stress is not relieved by exercise. So it’s important if we look at stress so we can maintain our goals, maintain our visions. As Scott said, you have to have a reason to do it. So we can’t let stress get in the way of moving forward. Next slide please.

There are three different kinds of stress. There’s situational stress, which is caused by the environment around you. Somebody jumps in front of you. You’re driving your car, someone jumps in front of you, you slash on the break. Every system in your body goes into stress. There’s physiological stress and this is the body’s response to trauma. Insomnia, sleep disorders are physiological stress.

Giving birth is physiological stress. Head traumas are physiological stress. This is stress that you really can’t control. And there’s psychological stress. Psychological stress is mostly self-induced. You get a Dion exam. You are way stressed out. You get diagnosed with bladder cancer, you’re way stressed out. But the key is that like this guy holding the ball, only you can control the squeeze of that stress is putting on you.

So I’d like to focus, next slide please, on the psychological stress because that’s really what we’re dealing with. And we all tend to be hard on ourselves. As Scott had said, we do a lot of self-talk, which is very detrimental to us. It is ineffective, it is self-sabotaging and it’s a very difficult habit to break. But if you believe in change, you can relieve the stress, you can believe in your goals, you can create a new you. You can stop being hard on yourself. I would suggest maybe you take some post-its and stick them up on your board like this and try to stop being hard on yourself. It’s not an easy thing to do. It takes time. Next slide please.

So let’s talk a little bit about stress management. Stress management, you can be either reactive or proactive. This guy here holding up these blocks is being very proactive. He is making sure and looking at why it happened in the last place and stopping it, why it happened in the first place and he’s stopping what’s going on.

But most of us are reactive. I must say that no matter what action you take against stress, no matter what activity, exercise, it’s excellent because you are dealing with stress. It’s working. But what you’re doing is you’re managing the symptoms. And the problem with managing the symptoms is they can come back at you, they can overtake you and the stress can become a part of your life again. So it’s very important that you learn how to manage the psychological stress by reaction and proaction. So what I’d like to do is now look at the proactive side of this stress management. Next slide please.

Now first… Sorry, let’s look at the reactive side for just a minute because we’ve all tried these different methods. I mean, here’s a little list. Obviously, physical exercise is good. Mental exercise, yoga. Yoga begins to slip into the proactive. But any one of these is excellent. They are reactive though.

Hugs. I love hugs. Have you guys tried hugging lately or any of you real huggers? I’d like to hug. If you’ve never done it before, which is kind of odd, I’m sure, give it a shot. You’d be surprised how nice it is. But things like yoga, which do move into the proactive side are really the best place to start managing psychological stress. So next slide please.

So when you’re thinking about proactive management, there’s really only three options you have. You can think out of the box and you can look at things differently. You can look at stress differently. You can think about how it affects in a different way. You can change your selfie. It’s what you see, what people see about you, what you want them to see. You can write a new elevator pitch. You can tell a new story.

And once you embrace these three things, then you got to look at stress and embrace the stress, and embrace the change. Now, would you do me a favor? Just make sure you’ve got your camera ready. I’ve got a little project for you in a couple slides. If we were in a meeting, I’d explain it to you, but we’ll go over that in a couple slides. Next slide please.

So let’s talk about thinking out of the box for just a minute. Our self-perception, our self-esteem, our self-confidence, this is what defines us. This is what defines our personal space. It’s that boxing rhythm. It’s how we deal with this perspective that determines how we move forward. I’ve got here, wherever you go… There you are. And sadly this is true most of the time.

One of the ways to change that is to think out of your box. Be like the Queen in Alice in Wonderland. You guys know the Queen in Alice in Wonderland? One of her things was she would wake up every morning and before breakfast she would think of 10 new and exciting things. So let’s try and be like the Queen in Alice in Wonderland. Next slide please.

So the second thing I had was redoing your selfie. Now, I’m curious, first of all, since your selfie is what people see, can anyone there relate to one of these? Are you like this little guy on the left, on the left that’s just plugging himself into a sock and he’s got a bad hair day? Or are you one of these people that are smiling all the time? If you’re not sure, ask someone. Ask someone what they think of a picture of yourself, you took with yourself, that you took of yourself.

Now I know it’s difficult. It’s kind of impossible to see yourself as others see you because we look at ourselves, same eyes, same body, same person. And no matter where we go, we’re always the same person. We’re there. But try to recreate yourself on that selfie. I asked you to take your cellphone out in a while, but I have it ready for you. I’ve started to say here, if we were in an audience together, I would ask you to take a new selfie and ask the person next to you what message you’re giving them.

So all I can ask you do is take a selfie and maybe share it with us at the end during… Maybe you could show it to us or something or email or send the picture through the chat, through the Q&A chat. I’d like to see that, see what it is. But part of that selfie… Next slide please. Part of the selfie is what you say to people. It’s like your elevator pitch. My question, I guess is do you have an elevator pitch?

Is it an old one or is there a new one since your diagnosis and your treatment and where you are today. You meet someone in the elevator. He’s new, he walks in the elevator, he says, “I just moved into the building. I’m in apartment 10F. I don’t know anyone. Hello, who are you?” What are you going to tell me? What I’d like you to do is take a minute and come up with yourself. Now, before you do that, if you remember when I started, I said, “Hello, I am Mark Block. I am a certified personal trainer and life coach. I am the creator and host of a wellness website called risa.com,” which I summarize as the crossroads between health and fitness, health and nutrition, health and wellness. Sorry.

Well, that took all of 17 seconds to say that. Come up with something that you could tell us in 30 seconds and I’d like you to think about it. And maybe at the end you can put it in the Q&A chat and maybe we’d happy to read that to you. So I’d like to know who you are.

And if that happens… Next slide please. And if you didn’t get that, you’ve actually, if you can think out of the box, if you can change your selfie. If you can create a new elevator pitch. You are becoming a new you and it’s a different kind of exercise you’re doing. Now, you’re going to be able to focus. As Scott said, you’ll have a reason to do it. You can set yourself goals. But what’s next? You have to embrace stress and you have to embrace change. You have to make these things work for you. Next slide please.

Now embracing stress. Stress has amazing benefits. It’s a motivator. It gets your creative juices going. It’s an indicator of needed change. It mobilizes you. It doesn’t stop you. It can keep you going. And it has some amazing longevity issues. It strengthens your body. Today, we think that we have the key on longevity and finding that fountain of youth, which stress can do for you. But people like [inaudible 00:32:45] history Ponce de Leon, he was crazy. He was obsessed with trying to find the fountain of youth.

I’ve got here something from Sophia Loren. And Sophia Loren says that she has found the fountain of youth. She goes, “There is a fountain of youth. It is in your mind, your talents. It’s in the creativity you bring to your life and the life of the people you love. When you learn to tap this source, you will truly have defeated age. You will have found your fountain of youth. So my message here is embrace stress because it’s inevitable. It’s there in front of us. It’s make it for you, not against you. Next slide please.

And from there we have to embrace change. Change is inevitable. Change is part of life. Change is one of those inevitabilities. Change and stress, they kind of go hand in hand. There’s a natural progression. Most of us don’t like change. We get stressed whenever there’s change. So we get stuck in our box because of it. So we’re back to the whole premise of thinking out of your box, changing your selfie. Change your elevator pitch. It’s all about change. But change takes time. You have to practice it and take small steps one at a time. Next slide please.

So now that we have some new great habits, has anyone here ever read anything about the Blue Zone studies? These are studies where they looked at the longest lived people in the world, those centurions around the world, and they came up with nine lifelong lessons.

I suggest you go google bluezones.com and look at those nine lessons. But they all lead to one major thing. They lead to a purpose in life. And that to me is the most important lesson because if you can identify your purpose in life and always smile. I like these folks, this slide. I hope that I can maintain a smile like that. I hope that whatever stress I’m under that I can constantly reframe myself and move forward and smile like these guys are smiling. Next slide please.

So I’m going to leave you now with this theory that you can be the new you, that your new healthy habits can get you into that exercise routine. They can give you something to look forward to. They can give you a goal. So get to know the new you 2.0. Think out of the box, change your selfie and elevator pitch, accept change, and become that positive future because you can. Because the future is yours to write. Thank you so much.

Stephanie Chisolm:

That was really awesome. We talked about really the health benefit of rehabilitation and rehabilitation and getting your body ready for the marathon that sometimes accompanies a bladder cancer journey. And then highlighting the golden rule and those microbursts and thinking about your self-confidence change. I love the idea of changing yourself, your perception. Are you a person that is beaten down by bladder cancer? Are you living well with bladder cancer and showing people that you’re doing everything you can be and really living well and rewriting that elevator pitch.

I think we’ve had quite a few good questions that have come in and really they’re across the board in terms of who might be the one to address. Some were really focused on the medical aspect of it. So for Dr. Mossanen, are there any contraindications or concerns about doing strenuous exercise like running while in the middle of a BCG therapy in the sense of that? Or is there any warning signs that people should be looking out for if they’re having intravesical therapy and they notice blood in their urine, if they go out and do something strenuous. Is there something they should be paying attention to?

Dr. Mossanen:

I think it’s okay to exercise while on BCG therapy. In fact it might be helpful to cope with some of the side effects. If you’re noticing that you’re having bleeding though, you might want to reduce your activity, increase your hydration, see if it improves. And of course, I’m obligated to say contact your doctor if your symptoms don’t improve. But I think that even moderate activity could be good to help deal with some of the side effects of therapies like the bothersome urinary issues that patients might get.

So you might not be able to do the most intense exercise, but as we kind of discussed a microburst of activity or something. Just some movement is better than no movement. So I do think it’s okay to be active and to do some exercise during intravesical therapy.

Stephanie Chisolm:

Great. And we will have a question about the BCG in just a moment, but let me just ask another follow up. How soon after a TURBT do you… And in general do doctors suggest people wait before they go back to doing real physical activity or exercise?

Dr. Mossanen:

That’s a great question. It depends. If it’s a small little one centimeter tumor that’s been plucked and cauterized, then maybe within a couple of days patients can get back on their feet and back to their regular exercise program. If it’s a large tumor that required a very extensive resection and a catheter to help the bladder recover and heal, then you might have to wait. So it really depends, but I think even no matter which procedure you’ve had, getting up and walking immediately after surgery is very important for numerous reasons.

So I think getting active is the key theme to emphasize. The degree to which you can really push it if you really are that active and very eager to get back to your regimen, I think you just talked to your surgeon so that they can communicate how big the procedure was.

Stephanie Chisolm:

Okay. That’s a good point. So Scott, when you went through your treatment, you had BCG. Correct? So were there any side effects that really impacted you in terms of things that you experienced that perhaps you found a way around them? Dr. Mossanen, you were just talking about things that you might be able to do to mitigate side effects, but what kinds of things in particular like if you had burning with urination, obviously, you would be hydrating more, but was there something exercise wise that might have helped that?

Scott Eriksson:

Yeah. So it’s interesting question. One, it was exercise that made me realize I had a tumor to begin with. So a lot of things, I had blood in my urine after a really hard workout. And first I googled it and, oh, Google just said it’s because of my hard workout. Well, then it came back a few more times and that led me down the path of finding it earlier than I would’ve otherwise because of exercise. So that was a good thing.

After the resection, I think I had a catheter for six days and that did keep me from going to the gym. I don’t feel up for it. I’m sure no one else wanted to see me come to the gym with a catheter. But two weeks after my resection, the doctor gave me the okay to start working out and in the gym and I actually felt very strong.

Now, when I started those treatments and the side effects built up a little bit more over time, which I guess is fairly common, I found that I would be tired for about a day. So I wouldn’t go and do… Usually, try to schedule it for Friday afternoon, then I would just take Friday afternoon and Saturday off. And then Sunday I felt pretty good again and I was able to start exercising a little bit more and all that. There was one time where I decided to push it and exercise and work out anyways the morning after my BCG treatment.

What I found was interesting is it wiped me out for a few days. So for me personally, every case is different. We’re all unique just like everybody else kind of thing. But I found that if I gave myself that data rest then I was able to start exercising pretty effectively the next day after that. Other than that, it didn’t slow me down. I did change my workouts. At the device of one doctor, I stopped doing really long cardio. I stopped doing endurance work and focused more on short… Even when I’d go out and run, I’d run short sprints versus trying to do long distance and that seemed to work for me.

Stephanie Chisolm:

So Mark, I have a question for you to follow that up and put that mental health piece in there. So when you’re experiencing side effects that can be very uncomfortable or challenging, how do you continue to reframe your selfie, your elevator pitch to make yourself get through those? What do you suggest that people might be able to do to help change the little script that’s playing in their head when they’re experiencing discomforts and pain because of the treatments that they’re going through?

Mark Block:

Well, my experience is if we can start to do different things, little things like go to someplace you haven’t been before and talk to someone to get your mind into that new frame, you have to really begin small steps to get away from that. Go to an art exhibit. Talk to someone who haven’t talked to. Talk to them about what’s going on in your life. Talk about what you’d like to be. It’s really a matter of trying very hard to do something you haven’t done before.

Stephanie Chisolm:

Yeah. Okay. Go ahead, Scott.

Scott Eriksson:

Yeah. Sorry, Stephanie. I just want to make this observation about participating in master sports, whether it’s swimming or track and field, I noticed when I went to my first national meet after my resection, all of a sudden I was aware of all the other things that older athletes are going through. So I had the bladder cancer, but there was the guy with the new knees and the person with the shoulder surgery or the replaced hips and all that. And it made me realize as we get older, our fitness goals are really a little bit of a constant recalibration to the situations we find ourself in life. So it was very helpful for me to see that, yeah, there’s a lot of other people who are going through their trials and tribulations and things are having to overcome and staying active, and encouraged and enthusiastic about being fit.

Stephanie Chisolm:

Dr. Mossanen I have a question. A lot of patients who do end up having a radical cystectomy have ileal conduits and that of course could lead potentially to parastomal hernias. What are the things that you as a healthcare provider might suggest a patient do to reduce that risk or adapt in their desire for getting back and being active in such a way that they can do that but maybe not risk a parastomal hernia that could occur because of the conduit that they have, the type of urinary diversion?

Dr. Mossanen:

It’s a really good question. I’m thinking of a couple of my patients that are very athletic, yoga instructors and heavy duty cyclists. And so I will sometimes recommend that they get a support belt and wear it. It can be customized for the stoma and they can work with an ostomy nurse to do that. I usually have them put it on when they’re doing their activity. And the key thing is to really not let the body heal after the cystectomy. So I really encourage them to be patient and let their body heal for at least six to eight weeks before they really want to go after heavy activity. Even sometimes three months. So combination of the belt and letting the body heal or some of the suggestions for helping to reduce that.

Stephanie Chisolm:

Right. So now maybe you can recommend a little microburst of particular little areas that are not necessarily going to impact where the stoma is in some way. So now you’ve got a new way of thinking about that. So this is great. Are there any concerns about bike riding because that’s certainly. With other types of cancer like prostate cancer, that certainly can have an impact when you’re riding on a bicycle and everything else.

Have you seen anything or do any of you know anything about alternative, not just running or being an athlete themselves, but in the sense of using equipment like a bicycle to exercise or a treadmill for walking, those kinds of things? Any suggestions?

Dr. Mossanen:

I’ll just make a quick comment. I think we’re sort of like the rest of the people on this panel are highly competitive, established, accomplished athletes. But many people with bladder cancer are dealing with other health problems.

Stephanie Chisolm:

Good point.

Dr. Mossanen:

Or they were former smokers and their lung function is not great or they’re in the middle of chemotherapy. So I think that… My guess is that, and I really want to hear the other guys make comments too on this, but is that most patients with bladder cancer will benefit from just 20 minutes of walking a couple days a week. If we’re getting to the point where we’re doing highly vigorous like bicycle riding, then I think you might want to have a one-on-one conversation with your urologist or your medical oncologist or whoever it is about the degree of activity and some of the symptoms that you may or may not be connecting with that exercise. I just wanted to put that little comment in there.

Stephanie Chisolm:

Yeah, good point.

Mark Block:

Well, I’d like to jump in here just for a minute because I have a client… As a personal trainer, my clients, my bladder cancer clients are at all stages. And I have one client who I am… And he’s on the call now and I did a triathlon because I’m a triathlete. But if you manage it properly and if you can manage the stress. And Dr. Mossanen, you can correct me on this, he knows his limits. We ride 30, 40 miles at a time. We run once a week and we’re running six, seven, eight miles.

We’re in the pool. It’s his weakest point. But you can do it. If you manage it properly, you understand your limits and you understand the implications, possible implications, there’s not much you can’t do. I’ve seen it firsthand with my clients.

Scott Eriksson:

Stephanie, I agree with what Mark is definitely saying and it sounds like certainly a lot of wisdom coming from Matt. One of the things that I’ve done is some people that I’ve worked out with is we’ve had ailments and we wanted to get some walking in, but maybe we didn’t have that much time to go for 20 minutes or we wanted to have a little bit the feeling of support is I’ll walk in the pool. It gives me some resistance, but gives me support as well. I feel like I can get some work in without actually having to go on a long walk or a long run.

So just a little tip of, it’s a little bit like a microburst, right? Just walking in the pool. Not over my head. I’m tall so make sure it’s on the shallow section, but I found that to be really good way to get some endurance work in without overtaxing the body and giving myself some support as well.

Stephanie Chisolm:

Right. Yeah. So I think it’s important to remember that just because you’re paying attention on this program or you’re watching the recording, you’re not suddenly going to be a competitive athlete at age 65 if you didn’t start as a competitive athlete your whole life. It’s not going to happen right then. But you are able to build exercise into your day, fitting into your signs and symptoms and treatment. As Dr. Mossanen is saying, always check with your provider. Make sure that they know what you’re doing so that if you end up with any problems, they know how to help you, I think would be a really good point.

And that it’s not just physical, but it’s also very mental and those are some things that all lead ultimately to wellness and thriving and doing well. So those are some key points that I think this webinar really brought out to me. As a participant on the webinar, do you all have any other closing comments? Because this has been phenomenal and as I mentioned, I think, Scott, I’d love to get some pictures or links to any of the other exercises. And Mark too, we can put the links into the transcript as we create that and we post that on our website. I think it’ll be an invaluable resource for a lot of patients.

Mark Block:

I would just like to make another comment on this pro-athlete issue. I think it’s important. Most people are not the kind of athletes that we are on this call. Most people, as you said, if they can do the recommended required minimum daily requirements, they’re lucky. I really believe that it’s equally as important to step away from that a little bit. Yes, as Dr. Mossanen to improve exercise is critical before. You’ve got to be routine. The better shape you’re in, the easier the procedure is going to be. The easier it is your recovery is going to be, the quicker you’re going to get back on your feet.

But most people need to get through that. They’re not like we are. So one step at a time. Think about yourself and think about your elevator pitch. Think out of the box and make yourself realize how important this exercise is. I think that’s very important to get away from. Scott and myself who are just below pro athletes. It’s not reality for most clients.

Stephanie Chisolm:

Right.

Scott Eriksson:

I’d like to piggyback on that, echo it completely. One of the things, the people that have gone through the microburst workouts, it’s a flat resistance band. Any of us that had any health issues, as we’ve matured through life, we probably have resistance band from the PT somewhere. But if not, you can get one easily. And the people that we had go through our program were all ages. It’s really interesting, the story one guy, finally got his 98-year-old father working out with him doing these because again, it’s so easy. But you’ll really feel, just to add a little bit of resistance with the resistance band to any movement. Even if you’re walking is just a great way to get started no matter what level you’re at.

Stephanie Chisolm:

Super.

Mark Block:

Well, by the way, did anyone take a selfie, I asked for? Did anyone redo their elevator pitch in the last 15 minutes? Just curious.

Stephanie Chisolm:

Raise your hand if you did. There’s a little raise hand button. Let me go to the participants and see if anybody’s got their hand up.

Mark Block:

Come on. Somebody raise your hand.

Scott Eriksson:

I did.

Stephanie Chisolm:

Scott did. Scott rewrote his. So Scott, what’s your new elevator pitch?

Scott Eriksson:

I love me some me. No, it was really grateful to be here and living heroically.

Stephanie Chisolm:

Excellent.

Scott Eriksson:

Which I guess I didn’t really rewrite it. I’ve been saying that for a while, but I wrote it again.

Stephanie Chisolm:

Well, this is good. So I think absolutely one of the things that I think you’ve done, Mark, is you’ve planted the seed. People are going to start doing it. They’re not going to do it right away to share. Especially with the Zoom, I haven’t seen anybody with their hand up. However, I hope you planted a few seeds. And we started and we should always wrap up with a medical perspective. So Dr. Mossanen, what have you got to say to wrap us up?

Dr. Mossanen:

Oh, boy. I think it’s been a very nice opportunity for me to learn from these two guys and go through all the benefits. But I think just the most basic thing I can say is that some activity is better than none. And most patients are dealing with bladder cancer. It’s a heavy thing to carry. So just even if you’re getting out there for 10 minutes a day, it can help. So just get out there and move. That’s my final comment on all of it.

Mark Block:

It’s a great comment.

Stephanie Chisolm:

Awesome. I think that actually wraps it up. I don’t see any more real questions. There was just one question. “Have the speakers ever seen lesions on cystoscopy caused by exercised induced hematuria? I’ve seen a case report describing this and worry that if there are red lesions on the bladder wall caused by exercise, it could resemble CIS carcinoma in situ and I would end up having to go through a TURP again when that might not be necessary.” So Dr. Mossanen, that’s a question, a technical question for you. Have you ever seen lesions that were caused by exercise?

Dr. Mossanen:

I think that’s a very unique case. And given that this is a webinar, I think my answer would be probably just go through that with your urologist because it depends on their history of cancer, the type they have, the degree of leading and all. It’s a very good question. I just think it probably needs a one-on-one answer.

Stephanie Chisolm:

Again, when in doubt, they’re going to want to check it out and make sure. Is it exercise induced or is it a return of the cancer? It’s really hard to tell without the microscope. So again, always refer back to your doctor. So thank everybody for joining.