Jo Hine was undergoing a medical test she wasn't particularly eager to endure when two familiar voices showed up. Kendra Johnson and Margo Sorum weren't actually in the room, but Hine could hear them anyway.
“Okay, take a slow breath,” she remembered them saying. “Breathe in. Hold it for the count of four. You've got this. There's no wrong. There's no right.”
Hine followed the voices in her head. She breathed the way she had been taught in the yoga classes Johnson and Sorum lead twice each week at Memorial Medical Center and she got through it.
“I could literally hear them inside here going, ‘This is going to be fine. I've got this,’” Hine said. “To me, that was remarkable.”
It was also an example of something larger happening in a program that grew from one cancer survivor's frustration with what her body could no longer do. Through a partnership involving Cancer Warriors and Memorial Medical Center, Johnson and Sorum lead yoga classes designed around cancer patients and survivors, along with caregivers and others whose lives have been affected by cancer. The movements are modified. Strength, balance, breathing and bone health matter more than mastering a pose.
Underneath it all is another goal: helping people learn to trust their bodies again. That need was personal for Johnson.
She practiced yoga regularly before being diagnosed with cancer. Surgery and radiation left her with diminished mobility on her left side, and the classes she once enjoyed no longer worked for the body she had after treatment.
“Nobody was offering modifications, no one was offering suggestions, and I always just left feeling defeated,” Johnson said. “So, I kind of just gave up.”
The idea for something different came to her while receiving chemotherapy. After treatment, she became a certified yoga instructor, intending to create the class she hadn't been able to find.
Then she met Sorum, a yoga therapist with about 15 years of experience who had started a similar program in Anchorage, Alaska. Johnson had the idea but wasn't convinced she was ready to carry it through. She suggested Sorum do it instead.
“I would love to help you and be a part of it, but I'm not going to do it,” Johnson remembered telling her.
Sorum's answer was simple. “She said, ‘We're going to do it.’”
Sorum brought experience and a framework from the Alaska program. Johnson brought the perspective of both a yoga instructor and cancer survivor. Together, they built classes around people whose bodies might have been altered by surgery, radiation, chemotherapy or other treatments. That meant addressing something Johnson felt she had lost during treatment — autonomy.
“I was tired of not having any say in what was being done to me,” she said. “I realized it was being done to me to save my life. I get that, but I needed something where I had a choice.”
There is a neurological component to that need as well, said Paula Johnson, a neuroscientist and co-author of this story. Cancer and its treatment can disrupt systems involved in fatigue, sleep, stress and nervous-system regulation. Cancer-related fatigue is more than ordinary tiredness and can include physical exhaustion, poor sleep, difficulty concentrating, reduced motivation and diminished tolerance for stress.
Mind-body practices such as purposeful breathing, gentle movement and mindfulness may help patients regulate some of those systems. But they can also change how people respond to signals coming from their own bodies.
Instead of every uncomfortable sensation automatically becoming a signal of threat, a person can practice noticing the sensation, regulating the response and deciding what to do next.
“What we are teaching people is how to take care of their own bodies, how to listen to their bodies again, because that's something cancer treatment just kind of takes away from you,” Kendra Johnson said.
The physical changes can be visible. When the program began a little more than a year ago, Kendra Johnson estimated that 90 percent of participants couldn't get themselves comfortably down onto the floor and back up. Now, she said, they can.
“Every time we do something that requires some strength, I always say, ‘I wish I had recorded you on the first day of class,’” she said. “The things they're doing now, they weren't doing then.”
Chris Fassi feels that difference. Fassi isn't a cancer survivor. She was recuperating from open-heart surgery when her husband was diagnosed with stage four esophageal cancer. Caring for him meant Fassi never finished her own cardiac rehabilitation.
A friend who is a cancer survivor eventually encouraged her to attend the class. Fassi also practices a more conventional, strength-oriented form of yoga. She calls what Johnson and Sorum do “restorative-slash-recuperative yoga.”
“They make it so that almost anybody can do this,” she said.
The instructors teach about balance, bone health, movement and injury prevention. But Fassi sees another element.
“It's movement, but it's also relaxation,” she said. “It's also how to let your body and your brain function together.”
Controlled breathing can give a person some voluntary influence over physiological arousal, Paula Johnson said, while mindful movement combines attention, sensory feedback and motor control. Research has also found that mind-body practices can reduce cancer-related fatigue, with some studies showing reductions in inflammatory activity. But for Fassi, part of the healing is much easier to see.
“It helps you, number one, get out of your house and, number two, be around people and socialize,” she said. “But you also share something that you don't have to say anything about. They understand.”
Kendra Johnson hadn't anticipated how important that would become. About 20 people formed the core of the program early on and have continued attending. Classes now range from about 15 to 28 participants, she said, and those relationships have spilled beyond the twice-weekly sessions.
“They go to each other's birthday parties. They go to the winery,” Kendra Johnson said. “I never imagined creating a community would be part of it.”
She doesn't describe it as a support group.
“It's a friend group of people who have a shared experience.”
That experience includes caregivers. Hine has never had cancer herself, but she has spent much of her life caring for people who did. She cared for her mother through cancer and later for her husband after he developed esophageal cancer.
Her husband underwent radiation and chemotherapy before surgery led to a series of complications. After seven weeks in intensive care, Hine said, he asked to go home on hospice. He died five days later.
“So, I understand the trauma of cancer without ever having to go through it,” Hine said.
That's one reason caregivers are deliberately included.
“Caregivers get overlooked a lot of the time,” Kendra Johnson said. “The mental strain and stress of caring for a cancer patient is also hard physically on the body.”
Memorial's nurses and pharmacists refer patients and caregivers to the classes, Kendra Johnson said, and participants also come through the Desert Southwest Cancer Support Group. Being surrounded by people who have faced cancer provides something beyond exercise for Hine.
“They give me strength,” she said. “They show me that we are stronger than what we think we are.”
She has met survivors of pancreatic, esophageal, breast and colon cancers.
“There's always hope,” Hine said. “There's always hope. And without hope, we can't exist.”
Kendra Johnson calls what has developed a friend group. Hine uses another word.
“This is definitely family,” she said. “You go on vacation: ‘How was your vacation? Tell me all about it.’ ‘You seem a little quiet today. You okay?’
“We've become a tribe.”
And what Hine has learned from that tribe follows her into the rest of her life.
She uses the breathing techniques when she's anxious, stuck in traffic or standing in a long line at the grocery store.
“It's become a mental, everyday little voice in the back of my head, without even thinking about it,” she said. “You're getting upset, take a deep breath.”
The science behind that can become complicated. What it can accomplish is simpler. Breathing, mindfulness and gentle movement can help people notice what their bodies are telling them, regulate their response and choose what happens next, Paula Johnson said. In the process, they may restore some sense of agency over a body that cancer and its treatment have made unpredictable.
Hine has learned to make that choice.
The voices are still there. Take a breath. Slow down. You've got this.
Sometimes that voice sounds like Kendra Johnson. Sometimes it sounds like Margo Sorum. And increasingly, it sounds like her own voice.
Paula Johnson, Ph. D., an assistant professor of neuroscience in the Department of Medical Education at Texas Tech Health's El Paso campus, contributed to this story.
