I’ll try and keep this concise.
In June, I was diagnosed with a 3b melanoma.
In July, 14 lymph nodes were removed along with a large patch of skin.
In August, an infection and subsequent admission to hospital set back recovery significantly.
In September, I started a year long course of Pembrolizumab (immunotherapy).
In October I got back on the bike.
In November I began structured training.
As part of recovery I’ve chosen a couple of events in the new year to focus on … Paris Ancaster (75 km field, gravel, singletrack) in April, and the Epic 8 Hour in May. I’m not really chuffed about being competitive for either (hell, being on the bike next spring will be reward in itself all things considered), but I do want to enjoy the events. Should they go well and if the borders re-open I focus on some more competitive events later in the season.
Anyway, my program isn’t particularly heavy … 350 to 400 TSS/week spread over 3 to 4 rides indoors and out (trainer, mountain and fat bike). Two weeks on, 1 week off. It’s well within what I would have tolerated pre-surgery. I’m 58, had an CTL of probably around 50 before surgery and Training Peaks pegs it at 30 now.
Anyway, I’m toast … resting heart rate is way up, legs are jello, I’m sleeping an hour or two more a day than I would expect, and it takes probably double the recovery time that it would have 6 months ago. I’m experienced enough to know that I need to reduce the load and scale back.
In the normal course of things, I’d presume that I went in too hard, and my body and age were both conspiring to tell me to slow down. But given my performance and ability to recover in the past, I can’t help but think the Pembro (immunotherapy) treatment is contributing to the fatigue. Yesterday for instance I napped for an hour after 30 minutes shoveling snow. Urgh.
A search for insight hasn’t been particularly useful; Google turns up zero results linking immunotherapy, training and athletic performance and my oncologist is frustratingly obtuse … he says, yes Pembro can cause fatigue and yes keep exercising. Likewise, the published literature that IS available indicates that 35% of patients on Pembro experience SOME symptoms of fatigue and exercise can help mitigate those symptoms but they’re talking about modest exercise in largely deconditioned patients. Regrettably, I’m drawing a blank …
My questions therefore are this …
Are there folks amongst you who have trained through immunotherapy. And what have your experiences been?
Are there professionals here (an oncologist perhaps) who have trained athletes recovering from cancer or during treatment? Or might some here know of resources available to those in similar situations to mine?
And more specifically, I guess what I’d really like to know is …
Is it reasonable to train through immunotherapy.
What might the expected load reduction be? Expected outcomes?
And am I being a damn fool thinking I’ll be ready for the spring season?