Andy Winnegar

After surviving prostate cancer, Andy Winnegar received a diagnosis of chronic lymphocytic leukemia (CLL) in 2021. Catch up on 

I am currently starting treatment with a BTKi, or Bruton’s tyrosine kinase Inhibitor, which represents an important advancement in targeted cancer therapies. These drugs were approved about 10 years ago following extensive clinical trials and have since become a cornerstone in the treatment of chronic lymphocytic leukemia (CLL). BTKis work by blocking a key enzyme, Bruton's tyrosine kinase, which is essential for the signaling pathway that drives the survival and proliferation of malignant B cells. By inhibiting this enzyme, therapy helps control the growth of CLL cells, slowing disease progression.

CLL is a type of cancer that originates in the bone marrow, affecting a specific type of white blood cell called lymphocytes. These cells are crucial for the immune system, helping the body fight infections. In CLL, however, they grow uncontrollably, crowding out healthy blood cells and impairing the body’s ability to fight infections. Despite being a form of leukemia, CLL is characterized by the slow and often indolent progression of these malignant lymphocytes.

As with any medication, BTKis come with their own set of side effects. I have new bruising and moderate night sweats and watch for any new infections. Additionally, in some cases, these drugs may inadvertently trigger autoimmune responses or worsen pre-existing autoimmune conditions, making the management of side effects a delicate balance. Each patient's experience with treatment is unique, requiring ongoing monitoring and adjustments. I have a blood test every week for the next six weeks.

We have a single daffodil outside our front door that blooms each spring. It serves as a poignant reminder of the delicate balance in nature — and, by extension, in life. The daffodil is a hardy flower, but like me, it is vulnerable to extremes. It wilts when the temperature shifts too drastically. Too cold, and it succumbs to the chill; too hot, and it withers in the heat. Much like the fragility of health, the daffodil requires care and understanding to thrive. It reminds me that resilience is not about avoiding change or hardship but about adapting to what is thrown our way.

As spring unfolds in Santa Fe, New Mexico, the weather in the foothills of the Sangre de Cristo Mountains mirrors this dance of resilience. The mountains, named for their reddish hue when covered in snow, stand as a symbol of enduring strength. The Spanish explorer who named them, impressed by their vibrant colors, called them "the blood of Christ" in 1719 — a name that endures as a reminder of nature’s permanence.

Surrounding Santa Fe are the Pueblo communities of Nambe, Pojoaque, San Ildefonso, Ohkay Owingeh, Santa Clara and Tesuque. These communities have a deep spiritual and cultural connection to the land. They have many names for the mountains in their native Tewa language — names rich with history and meaning but not easily translatable into English. Their connection to the land is woven through the centuries, shaping their way of life even as they face new challenges brought by drought.

The landscape here in Santa Fe is stark and beautiful, reflecting both the allure and the challenges of living in a high desert environment. The discomfort of extreme dryness and strong winds is forgotten when viewing the mountains, the blue sky and the dramatic sunrises and sunsets. Many artists have come here to paint, drawn by the brilliance of the colors and the clarity of the light.

The juniper trees are blooming this time of year, and clouds of pollen hang in the air, carried by the wind. It’s an annual reminder that the climate here is shifting in subtle yet powerful ways. Everyone in the community feels it, sneezing and rubbing their itchy eyes. Like many of my older neighbors and friends, I have developed dry eye syndrome, where the body does not produce enough tears. Fortunately, I found an effective eye drop medication that relieves my symptoms.

This year, we are amid a severe drought, with very little snow and no substantial rainfall during the winter months. As a result, fire season is arriving earlier than usual, and the threat of wildfire looms large. Like cancer, we must be on guard, prepared for change, and ready to find safer ground if necessary. That preparation is important, but we must not let it consume us with anxiety or worry.

These incremental changes in the climate create a challenging environment for gardening. Yet, much like the Pueblo people, we have found ways to adapt. The acequia system, a traditional network of community irrigation ditches, has been a key part of Pueblo agriculture for centuries. These ditches are not just physical canals; they represent a community effort to manage water resources collaboratively. The acequia system embodies self-governance and shared responsibility, teaching us that resilience is not only an individual effort but a collective one.

Adapting and Finding Strength in Uncertainty

Our gardening practices reflect similar strategies for resilience. By planting fruit trees closer to the house and growing vegetables in containers, we protect them from the unpredictable spring winds and cold nights. This approach mirrors my own journey with cancer. Just as gardening requires careful planning, adaptation, and resilience in the face of changing seasons, managing cancer demands flexibility and a strategic mindset.

It isn’t easy having cancer. But like gardening in a harsh climate, survival and growth come from strategies, adaptation, and patience. Every change — whether in the weather or the course of treatment — requires a thoughtful response. In this way, both gardening and health teach us the value of resilience: the ability to adapt, to adjust, and to continue growing, no matter the circumstances.

By aligning myself with the resilience observed in nature and the wisdom of the communities around me, I feel empowered to face the challenges of my treatment. Just as the daffodil, the Pueblo people and the acequias have adapted to their environment, we too, will adapt and thrive through this journey. It is our community, and we can do better working together.

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Articles

Bruton’s tyrosine kinase inhibitors (BTKis) have revolutionized chronic lymphocytic leukemia (CLL) treatment by targeting a crucial enzyme in malignant B cell survival. While effective, these therapies come with side effects, necessitating careful management and monitoring. The narrative draws parallels between personal health challenges and the resilience required in nature and community life, particularly in the context of Santa Fe's climate and cultural heritage. The acequia system exemplifies collective resilience, emphasizing the importance of adaptation and community support in overcoming adversity, whether in health or environmental challenges.

It isn’t easy having cancer. But like gardening in a harsh climate, survival and growth come from strategies, adaptation, and patience.

Managing Cancer Demands With Flexibility and a Strategic Mindset

As I prepare for the inevitable — though not death — I find myself on the brink of beginning treatment for my chronic lymphocytic leukemia (CLL). This transition brings a cascade of emotions: anger, apprehension and deep reflection on my journey with cancer.

I’ve lived with CLL for three years, heeding the CLL Society’s advice to delay treatment. Research supports this approach: starting treatment too early often means needing it again sooner with no measurable benefit. But as my oncologists at the UNM Comprehensive Cancer Center and Christus St. Vincent’s Regional Cancer Center have noted, the time for treatment will likely come in 2025.

The knowledge that treatment carries its own burdens — vulnerability to infections, fatigue, bloating and other side effects — has kept me vigilant and thoughtful about this next step.

Facing Fatigue and the Challenges of Aging

Of all the potential side effects, fatigue worries me the most. Running, even at a slower pace since turning 70 (I am now 75 years old), has been my solace. It clears my mind and quiets my anxieties. However, a recent fall while running left me with broken ribs, which sidelined me temporarily. The thought of treatment threatening this cherished part of my life is hard to bear.

Adding to this challenge is the frustration of aging itself. Time chips away at my endurance and strength, which amplifies my concerns as I approach treatment.

This is not my first brush with cancer. Years ago, I faced prostate cancer, now in remission. CLL, a slow-growing blood cancer, is a chronic condition and unlikely to claim my life. Yet it heightens my susceptibility to other cancers — a persistent, if not looming, threat.

Despite these realities, I remain focused on living. Researching my options and understanding my disease has empowered me to embrace the present. I take joy in my family’s milestones.

My wife stays active with yoga, swimming, biking and we often take walks together. My mother, who will turn 97 years old on January 1, 2025, lives nearby in Santa Fe, New Mexico, keeping close ties to our family. My daughter has two young girls, aged one and three, and my son recently welcomed a baby boy. These bright moments are a constant reminder that life’s beauty persists, even in the face of health challenges.

If there’s one thing cancer has taught me, it’s that while some of us may be predisposed to the disease, we can still take steps to lower our risks. My father, who lived to 100, managed his blood cancer alongside other age-related disabilities. While he followed his doctors’ advice, his lifestyle wasn’t always healthy.

A balanced diet, regular exercise and avoiding environmental pollutants like dirty air and water can significantly reduce cancer risks. Many in my generation grew up unaware of these connections. Smoking, excessive drinking and exposure to toxins were commonplace.

For younger generations, cancer prevention is less about undoing the past and more about making informed choices today. Balancing career, family and health while prioritizing screenings and preventive care can make a lasting difference.

The American Cancer Society recommends that screenings for colon, breast, cervical, skin and prostate cancers begin at age 45. For those with a family history of cancer, early screenings are especially critical. A healthcare provider can help tailor a screening plan to your needs.

Cancer may feel inevitable, but it isn’t. By embracing healthier lifestyles and prioritizing early detection, we can fight back. As I prepare for this next phase of my journey with CLL, I remain hopeful, grateful and committed to living fully — one day at a time.

The author reflects on their journey with chronic lymphocytic leukemia (CLL), emphasizing the emotional and physical challenges of impending treatment. Despite the potential side effects, such as fatigue, and the added burden of aging, they remain focused on living fully. The narrative highlights the importance of lifestyle choices in reducing cancer risk, drawing from personal and familial experiences. The author underscores the significance of early detection and preventive care, advocating for informed health decisions. They remain hopeful and committed to embracing life amidst health challenges.

As I prepare for treatment of my chronic lymphocytic leukemia, I reflect on the challenges of aging and side effects while staying focused on living fully.

Preparing for Treatment: A Personal Reflection on Cancer

I’ve worked with a lot of support groups working in disability rehabilitation since 1974. The population of people with disabilities is diverse from developmental intellectual disabilities, blindness, deafness, spinal cord injuries and chronic illnesses.

It wasn’t until I was diagnosed with chronic lymphocytic leukemia that I discovered that not everyone knows how to run and manage a support group.The first problem I noticed was too many people in the virtual room. I attended three different online CLL support groups. The first was a group of around 20 individuals at various stages of CLL.Some had experienced secondary cancers, and some had severe side effects while others in the room were in watch and wait status.

This support group was a round robin where each person took a turn telling what was happening with their CLL.It was hard for me to understand the various treatments that folks had endured.Also, for those who were impacted by secondary cancer it was difficult to provide support outside of saying how sorry you were that they were having these issues. At the same time, I had difficulty sharing my thoughts as I was only in watch and wait and did not have the experience of those already in treatment.

My second support group again had too many people in various stages of treatment and only one or two in watch and wait.What really made this support group difficult was that rather than a Zoom meeting it was a group texting effort. When a person entered the virtual room there would be many greetings and updates but because the texts were coming in from everyone it was hard to keep up. Those who had side effects from treatment tended to text the most about their difficulties and many didn’t have a chance to say anything.

Happily, the last support ground I attended was well managed and only for those in watch and wait status. The moderator explained what symptoms would require treatment.Here is a quick summary.

Fever over 100.5 degrees F (38.0 C) for more than 2 weeks without evidence of infection

Night sweats for more than a month with no evidence of infection

Unintentional weight loss of more than 10% in the last 6 months and

She also took the time to answer questions that had been provided earlier or were asked when someone raised their hand.

She didn’t allow anyone to dominate the conversation and reach out to those who hadn’t said anything.

I worked with individuals who experienced severe disabilities in the Independent Living movement. Here are some of the rules we followed for support groups.

You want to have people who gather to share common problems and experiences associated with a particular problem, condition, illness, or personal circumstance. It is helpful to have an experienced person who has lived with a spinal cord injury to talk to someone who has completed inpatient rehabilitation.

In a support group, it is important that people are able to talk with other folks who are like themselves - people who truly understand what they're going through and can share the type of practical insights that can only come from firsthand experience.

Effective support groups should have these features:

 - people who are all directly affected by a particular issue, illness, or circumstance.

They usually have a professional or volunteer discussion leader or facilitator.

They tend to be small, to better allow everyone a chance to talk.


Managing a cancer support group isn't easy.

Cancer Support Groups

I regularly attend these therapy sessions to explore and better understand my emotions. One of my fears is that if I accepted the sadness of depression and let myself cry or feel down, I might not escape from those feelings. I grapple that apprehension of facing the depths of depression might lead to an inescapable quagmire of emotions.

According to my therapist this type of denial can be harmful. As she said, running away from your own feelings will eventually catch up with you. You are basically running away from yourself. Denial of grief is a coping mechanism and it will need to be dealt with or it may come out in other ways. In my case, my drinking increased and this self-medicating dulled my emotions, but I was still depressed.

In my ongoing journey of dealing with cancer, I've been working on managing my emotions more effectively. I've been learning to navigate my emotions using the mindfulness full body scan technique.

When going through the process from feet to head, my thoughts, worries and feelings pop up but rather allow the distraction that these thoughts must be set aside.

That is something that will happen and understanding these thoughts and worries are an important part of the mindfulness process.

The full body scan is a way to cultivate awareness of physical sensations and promote relaxation.

Find a quiet and comfortable place to sit or lie down.

Begin with posture: If you're lying down, make sure you're in a comfortable and relaxed position with your arms at your sides. If you're sitting, sit with your back straight and your feet flat on the floor. Close your eyes if it helps you focus.

Take deep breaths: Begin by taking a few deep breaths to center yourself. Inhale slowly through your nose and exhale slowly through your mouth. This helps you relax and prepare for the scan.

Start from your feet: Begin the body scan at your feet. Focus your attention on your toes, the soles of your feet and your heels. Notice any sensations in these areas, such as warmth, coolness, tension, or relaxation.

Move upward: Gradually shift your attention upward, moving to your ankles, calves, knees and thighs. As you do, continue to observe any sensations without judgment.

Continue through the body: Progress through each part of your body, from your hips to your abdomen, chest, back, shoulders, arms, hands, neck and head. Take your time with each area, allowing your attention to linger for a moment.

Stay mindful: If you encounter any areas of tension, discomfort, or pain, observe these sensations without reacting or trying to change them. The goal is not to change your physical sensations but to become aware of them.

Mindful breathing: Throughout the body scan, maintain awareness of your breath. Your breath can be an anchor to the present moment. Notice the rise and fall of your chest or the sensation of the breath as it enters and exits your nostrils.

Acceptance: Practice non-judgment and acceptance. It's normal to have various sensations in your body and the purpose is not to label them as good or bad but to simply acknowledge them.

Conclude: When you've completed the scan, take a few deep breaths and slowly bring your attention back to the room. Open your eyes if they were closed.

You can adjust the duration of the scan to fit your needs, but it's often done in 10-30 minutes. Over time, regular practice can lead to increased relaxation and a deeper connection with your body.

I've realized that delving into depression and allowing myself to feel sad doesn’t result in being overwhelmed by grief or any loss of self-control.

Understanding the importance of sharing emotions with family and friends is a crucial lesson. I’m still working on being more open. I appreciate the intimacy I share with my wife and it does alleviate my sense of social isolation since my cancer diagnosis.

Reflecting on these experiences and trying to confront the realities of my diagnosis and potential treatment have been impactful. I haven’t often expressed my true feelings.

But rather than face cancer by myself, I have found this type of intimacy by being open and expressing my true feelings with family and friends. It has been beneficial as I feel less socially isolated and alone.

I see a psychologist who is helping me to understand my feelings and to learn mindfulness meditation techniques.

Andy Winnegar

Managing Cancer Demands With Flexibility and a Strategic Mindset

Preparing for Treatment: A Personal Reflection on Cancer

Cancer Support Groups

A Full-Body Scan: The Reality of a Cancer Diagnosis

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