Modifications for a female recently post breast cancer treatment

[sashephe]

Kind of a long shot, but I've seen a couple mentions of women in similar situations on the forum, so I figured I'd post something and see what you folks think. My wife recently completed most of her treatment for breast cancer. She had a great result (complete response) and expressed interest in taking her lifting more seriously now that it's largely over. Having done SS in the past, and having had good results, I figured that was a good place to start. She had been lifting though treatment, but only had access to 15-50lb dumbbells, so it was more haphazard (lots of increasing volume, until she was ready to make the 10lb jumps, different exercise selection, etc).

Now we're both doing SS together, and I'm trying to help her as much as I can, but I am by no means an expert, having done the program once 10 years ago, read (and now rereading) the blue book, and otherwise spending a handful of years here and there in the gym.

The situation is as follows. Chemo, radiation, and bilateral mastectomy are complete, and largely recovered from, with a few lingering affects. She's still on a PD-1 inhibitor through the end of January though. The cumulative effects of this seem to be causing some mild adrenal dysfunction (evident in bloodwork, not just guessing based on symptoms), which I suspect may be limiting her ability to recover from workout to workout. It is also necessary for her to take 5 days off every 3rd week, surrounding the day where she gets her infusion. If she does anything more intense than yoga within that window, she gets debilitating muscle soreness.

We're now about 1.5 months into the program, and at a point where she's hitting a wall on everything but squats which she's doing 5s on still, everything else is 3s. Been through a reset on squats, bench, and DL already at varying times, but never everything at once. Could it be that she's at the limit of her recovery capacity, albeit artificially low due to circumstance? What would that look like? Any modification in order, or just reset weights and keep pushing? Stats below

31 yr old female
118lbs, 5'1"

s-125 3x5
b- 67.5 5x3
dl- 145 5x3
p- 52.5 5x3
pc- 45 (trying to get form down before adding weight)

Apologies for the small novel, just trying to get any relevant information I can think of in there. Any help is appreciated.

[Hayden-William Courtland]

Are the first three questions dialed in: The First Three Questions | Mark Rippetoe? Is she still having to take a week off every third week? How is the wall manifested: is she just missing reps or is she feeling drained as she starts her workouts?

[Elle]

I have absolutely zero experience with cancer, and limited experience lifting. However, I do have experience with adrenal problems. I originally started my lifting journey with CrossFit which was way too much for my sensitive adrenal system and quickly led to high cortisol and thyroid disregulation.

The most obvious thing I see is 5 sets of deadlifts. I would take that down to 2 sets of 3. Deadlifts are so taxing on the system as a whole that it's probably consuming all of her capacity. And more than 2 sets of 3aren't required (per either the Blue Book or practical programming section on women, I forget specifically where it's addressed).
In fact, Practical Programming might be a good read. Whether her recovery capacity is artificially low or not, intermediate programing is for when you can no longer recover sufficiently from novice programming.

The biggest trick for me to be successful when lifting was to manage intensity. Volume I can do but intensity quickly causes problems. Whenever I'm feeling good, I'm tempted to put more weight on the bar or go for extra sets, but that almost always leads to failed sets a few days later. It's better to just let myself have a successful day and have extra energy the next day.

If you can get your hands on a device like Oura or Whoop that measures day-to-day heart rate variability, this can be a really useful tool for understanding her body's work capability on any given day.

Adding a light squat and/or a light deadlift day once per week might help keep her total fatigue down. With my whoop I didn't have to stick to a strict once a week light day, I could just wait until my recovery score showed I needed it. But if you don't have one, the worst that happens is you take a few extra light days. And really, is adding 10lbs to the bar each week instead of 15 that big a deal?