Dharma Talk

Contributing med­i­cal ed­i­tor Ti­mothy McCall shares his in­te­gra­tive can­cer-treat­ment story.

Yoga Journal - - CONTENTS - By Ti­mothy McCall, MD

When a physi­cian found him­self in the pa­tient’s chair—di­ag­nosed with can­cer in his neck—he didn’t go straight into con­ven­tional treat­ments. In­stead, he trav­eled to In­dia to see an Ayurvedic ther­a­pist. He shares his chal­leng­ing jour­ney and how he used a com­bi­na­tion of East­ern and Western medicine to heal.

WEAR­ING ONLY A MUSLIN

loin­cloth, I lie on a hard­wood ta­ble stained the color of ma­hogany from years of oil mas­sages. A warm breeze flut­ters a sun-bleached crim­son sari mounted length­wise on the wire-screen wall that sep­a­rates the treat­ment room from the gar­den and co­conut palms out­side. Kr­ishna Dasan, the Ayurvedic ther­a­pist work­ing on me, glides an oily satchel filled with freshly cut leaves, gar­lic, and le­mon in long strokes from my chest to my legs. Some­times along the way, de­tect­ing a stub­born area of mus­cu­lar tight­ness, he stops and rubs back and forth over the stuck area for a num­ber of stac­cato strokes be­fore re­sum­ing longer ones.

When the bag cools, Kr­ishna hands it to his as­sis­tant, Shashi, who puts it back in turmeric-in­fused oil bub­bling on a sin­gle-burner gas flame and hands Kr­ishna a hot one. Af­ter pound­ing the satchel once or twice on the ta­ble to cool it and re­move ex­cess oil, Kr­ishna traces firm cir­cles on ei­ther side of my chest. The air is fra­grant with a smell more like food than medicine, vaguely rem­i­nis­cent of home­made pea soup.

Be­cause he is wor­ried that the hot oil might cause the metastatic can­cer cells in the lymph nodes of my neck to spread, Kr­ishna mas­sages

that area only lightly. A few days be­fore we’d be­gun these treat­ments, his guru, Chan­dukutty Vaid­yar, an el­derly Ayurvedic physi­cian, had warned him to be care­ful. Nor­mally, Vaid­yar, whose name is the Malay­alam word for “doc­tor,” re­fuses to treat can­cer pa­tients, but since I have been his stu­dent for years, he’s made an ex­cep­tion.

“I’m not ex­pect­ing Ayurveda to cure my can­cer,” I tell Kr­ishna. He seems re­lieved. “I just want to get as rested and bal­anced as I can be be­fore I un­dergo the heavy­duty treat­ments.”

I fig­ure the mas­sages and herbal reme­dies, which had helped me so much in the past, would at least give me a bet­ter shot at getting through what was to come. And al­though there is zero sci­en­tific ev­i­dence to sup­port the idea, I sus­pect they may even in­crease my odds of getting cured.

Hope in In­dia

A few days af­ter be­gin­ning this round of Ayurvedic treat­ments, I no­tice that my ton­sil is no longer cov­ered with a gray­ish film but is shiny pink and looks smaller in the mirror. When I move my fin­gers across the lymph nodes in my neck, as I’ve done thou­sands of times on pa­tients, it feels like they are also shrink­ing. Kr­ishna agrees. Over the next cou­ple of weeks, this trend con­tin­ues, with a pro­gres­sive, slight de­crease in the size of the tu­mors. I’m not think­ing this is go­ing to be suf­fi­cient to erad­i­cate the can­cer, so I’m still plan­ning con­ven­tional care, but it feels like con­fir­ma­tion that what I’m do­ing is al­ready mak­ing a dif­fer­ence.

In de­cid­ing to go to In­dia for Ayurvedic treat­ments be­fore com­menc­ing chemora­di­a­tion, I re­mem­ber some­thing that I learned in med­i­cal school: Can­cer is po­ten­tially life-threat­en­ing, but in most cir­cum­stances, it’s not an emer­gency. That’s why I shud­der when peo­ple hurry into treat­ments be­fore they’ve had a chance to care­fully con­sider their op­tions. By the time a can­cer is di­ag­nosed, it has of­ten hid­den in the body for years, some­times for a decade or more. This is why a few weeks de­lay—un­less there is a crit­i­cal sit­u­a­tion, such as a tu­mor ob­struct­ing a breath­ing tube or com­pro­mis­ing an­other vi­tal struc­ture—usu­ally won’t mat­ter much. What is cru­cial to me is to get the best care pos­si­ble, not, as I’ve heard pa­tients say, to “get the can­cer out of me as soon as pos­si­ble.” I have the lux­ury of not be­ing in an emer­gency, so I am able to do ex­ten­sive re­search, talk with loved ones, con­sult col­leagues, and get sec­ond opin­ions from other health-care pro­fes­sion­als.

Chemo­ther­apy be­gins

Less than a month af­ter In­dia, I ar­rive at a ma­jor med­i­cal cen­ter in the south­east­ern United States for can­cer treat­ments. The air con­di­tion­ing in the hos­pi­tal is freez­ing. I’m wear­ing a ma­roon stock­ing cap, one of sev­eral that my sis­ter-in-law, Made­lyn, bought for me. Be­fore the chemo­ther­apy drug Cis­platin is in­fused,

Holis­tic sys­tems of medicine work like an or­ganic gar­dener who makes plants (in this case the body) hardier by strength­en­ing the soil rather than sim­ply pour­ing on pes­ti­cides.

the nurse brings a pa­per cup with two anti-nau­sea pills. One is a pow­er­ful cor­ti­cos­teroid called Decadron. The other pill is a pop­u­lar new antin­au­sea agent that is said to be much more ef­fec­tive than the drugs that came be­fore it.

Just in case, though, to help pre­vent nau­sea, I’ve drunk noth­ing but warm wa­ter for the past two days. I made the de­ci­sion to forgo food af­ter read­ing a re­port in an on­col­ogy jour­nal that found pa­tients who fasted dur­ing their chemo treat­ments re­ported lit­tle or no nau­sea. Sit­ting in the in­fu­sion cen­ter, I chew on slices of fresh ginger I’ve brought from home—an Ayurvedic rem­edy for nau­sea.

As the yel­low con­tents of the small bag of Cis­platin drip into a larger bag of saline run­ning into a vein in my arm, I do not think of it as a toxic drug, even though I know full well that it is. In­stead, I imag­ine that it is a heal­ing nec­tar flow­ing into me and cir­cu­lat­ing through­out my body. I lie back on the vinyl chair, look out the win­dow at the few trees in this ur­ban land­scape, and silently chant mantras.

Yoga in treat­ment

The yoga pose that is prov­ing most help­ful to me is a prone restora­tive twist. To come into it, I sit with my bent knees to the right side of my body with my right foot cra­dled in the arch of my left. As I bring my torso down to­ward a cylin­dri­cal bol­ster, I twist my spine and my head to the left. Just be­fore my chest lands on the bol­ster, I turn my neck in the op­po­site di­rec­tion, so that my knees and head face the same di­rec­tion. My breath deep­ens as I sink in.

This is a beau­ti­ful stretch be­tween the neck and the rib cage, help­ing me pre­serve move­ment threat­ened by the chemora­di­a­tion. And be­cause this prone twist is a restora­tive pose, I can hold it for a long time. I’ve been tired and un­able to do much yoga prac­tice most days. Some morn­ings, just stand­ing and lift­ing my arms over­head feels like too much. I stay 20 min­utes in the twist, then come into the pose on the other side.

Yesterday, Made­lyn caught me asleep in the pose. I might have been there 45 min­utes. Nor­mally that never hap­pens.

The re­sults

Three months post-chemora­di­a­tion treat­ment, I re­turn to the hos­pi­tal for an­other PET scan to eval­u­ate my re­sponse. I’m told that the ar­eas that lit up on my ini­tial tests seven months ago, in­di­cat­ing can­cer, have re­turned to nor­mal. Nei­ther of my doc­tors, both of whom ex­am­ine me care­fully, finds any ev­i­dence of can­cer in my mouth or lymph nodes. I have what they call a “com­plete clin­i­cal re­sponse.”

In my ex­pe­ri­ence prac­tic­ing medicine, can­cer treat­ments can be both overused and overly ag­gres­sive. For many ma­lig­nan­cies, in­clud­ing mine, an in­te­gra­tive ap­proach that in­cludes the best of mod­ern sci­en­tific medicine, but which also ad­dresses the many ar­eas of mind, body, and spirit that the field sys­tem­at­i­cally ne­glects, ap­pears to of­fer the best hope.

Holis­tic sys­tems of medicine such as Ayurveda and tra­di­tional Chi­nese medicine work like an or­ganic gar­dener who makes plants (in this case the body) hardier by strength­en­ing the soil rather than sim­ply pour­ing on pes­ti­cides. But some­times you need both. One as­pect of good holis­tic care is that it wel­comes treat­ments such as drugs and surgery when they seem like the right tools for the job. You might say the in­te­gra­tive path I chose to deal with the per­ni­cious in­vader that is can­cer in­cor­po­rated the toxic chem­i­cals of chemo­ther­apy along with the soil-en­hanc­ing ef­fects of diet, stress re­duc­tion, and gen­tle herbal reme­dies.

I didn’t choose this can­cer ad­ven­ture. But I see clearly that my choices set the karma in mo­tion that brought me to it. In try­ing to deal with it as skill­fully as pos­si­ble, given the

im­per­fect col­lec­tion of in­for­ma­tion I’d amassed by the time each de­ci­sion needed to be made, I did the best I could. And over­all, I’m happy with the choices I made.

All you can do is the best you can do at any given time and not sec­ondguess your­self. That’s skill in ac­tion— the Bha­gavad Gita’s def­i­ni­tion of yoga. Is it also yoga to use your life and strug­gles to learn and grow, turn­ing seem­ingly bad events into things that serve you. Yoga teaches that it’s pos­si­ble, through your ac­tions, to change some bad karma into good karma.

I chose the path of holism, tak­ing one small step at a time and try­ing to look at spe­cific as­pects of my sit­u­a­tion in hopes of shift­ing the whole in a help­ful di­rec­tion. I ad­dressed my struc­ture, my breath­ing, my ner­vous sys­tem, and my mind. In ad­di­tion to the Ayurvedic treat­ments, I had dozens of acupunc­ture treat­ments and reg­u­lar vis­its to a phys­i­cal ther­a­pist for body work called my­ofas­cial re­lease. And I con­tin­ued my jour­ney of psy­cho­log­i­cal ex­ca­va­tion, jet­ti­son­ing at­ti­tudes and be­hav­iors that may have served me in my dif­fi­cult child­hood but which I no longer needed.

As hard as I’ve worked to get through the chal­lenge of can­cer, I have also sur­ren­dered the il­lu­sion that I can con­trol it. Af­ter getting the news I’d been hop­ing for at my fol­low-up ap­point­ment, I learned that there is a 5 to 10 per­cent chance the can­cer will re­cur in the first three years. Op­ti­mistic as I am, I’m aware that my ef­forts may not have been enough. Part of my hope­ful­ness is that I know that if the can­cer should re­cur, I have tools to help me get through it. To heal even if I can­not be cured. To live how­ever much life I have left with joy and con­tent­ment and love. And the ur­gency the di­ag­no­sis has brought is to live life more fully, to bring even more pas­sion and dis­ci­pline to the work I feel like I’ve been put on the planet to do.

All you can do is the best you can do at any given time... As hard as I’ve worked to get through the can­cer, I’ve sur­ren­dered the il­lu­sion that I can con­trol it.

Adapted from Sav­ing My Neck: A Doc­tor’s East/West Jour­ney through Can­cer by Ti­mothy McCall, MD, © 2018 Ti­mothy McCall (Whole World Pub­lish­ing). McCall is the best­selling au­thor of Yoga as Medicine and has been Yoga Jour­nal’s med­i­cal ed­i­tor since 2002. Learn more at drm­c­call.com.

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