Category: Pelvic Floor

Pregnancy after Breast Cancer

Pregnancy after Breast Cancer

by bridewitt ♥ 2 Comments

Hi – it’s been a minute and…SURPRISE! If you didn’t already know – I’m pregnant! My husband and I are so thrilled to be expecting our first child in December, especially because we weren’t sure what this ride would be like for us. It’s such a blessing to be here three years post-diagnosis sharing this news!

First pic of our little buddy! ❤

I wanted to take this opportunity to write about a few of the normal and not-so-normal experiences I’ve had during this post-cancer pregnancy, because there are a few things I’ve had to consider beyond what someone without my medical history might experience. I also want to acknowledge that every person’s experience with conception and pregnancy is so different, and with so many dealing with the heartbreak of infertility, I want to be as respectful as possible. What works for me, may not be helpful to your experience. I send my love to anyone on their family building journey, however that may look!

Conception Concerns

Conceiving naturally after breast cancer treatment was NOT a given. You’ve all read my saga of a fertility preservation journey through cancer… Thankfully, though, natural conception is not impossible! I remember speaking with my fertility specialist when we were starting the egg-freezing process prior to chemo and asking him what percentage of people do conceive naturally after treatment and then proceeded to blurt out “Well, you probably don’t get to see those patients return anyway!” when he told me it’s “not likely.”

From the moment I realized that infertilty after cancer was looming, I decided to change my mindset. I decided I’d do whatever I could to support my body during and beyond cancer treatments to give me the best chance of conceiving naturally (because, not sure if you’ve heard, but IVF is expensive!!!).

Here are some of the ways I have tried to support my body’s ability to conceive from early in my diagnosis:

  • Eating a well-balanced diet (& actually switching from a primarily plant-based diet to a paleo diet)
  • Acupuncture
  • Seed cycling for menstrual support
  • Supplementing with vitamins, minerals, and antioxidants with guidance from my naturopath
  • Tracking my cycle and understanding my norms
  • Managing stress with meditation, tapping, and time outside
  • Positive mindset and visualization
  • Exercise!
  • Medically – Zoladex to protect my ovaries during chemo & Egg-freezing (oocyte cryopreservation) as a “Plan B”

Here’s a cool story for you…

If I haven’t mentioned it here before, I am a HUGE fan of my Oura ring for tracking my cycles and other biohacking purposes. Even before I had missed my period, my ring indicated elevated basal body temperatures and resting heart rate so I knew even before I took my first pregnancy test that I was likely pregnant!

And so I was just lucky (?) that I was able to conceive naturally this time around, but I can honestly say that I did what I thought I needed to do to support that. It may not be feasible or even physically possible for some or may just be all too much for others, but I just wanted to share my personal experience here.

Cancer Screening Change-Up

Prior to pregnancy, I was having an annual mammogram and an annual MRI (staggered every six months) to monitor for any signs of recurrence. I’ve never monitored tumor markers because mine were never elevated, and therefore wouldn’t give an accurate snapshot of my health. With triple negative breast cancer, the risk of recurrence is absolutely highest in the first three years and begins to taper down signficantly after 5 years of being cancer free. I had just celebrated my 3-year diagnosis cancer-versary in April when we found out we were pregnant, so I am definitely not out of the woods and screening are still important.

First of all, for the rule followers…my oncologist did clear me to try for pregnancy, and she knew I was pregnant before I even told my family!

Second of all, I obviously don’t want to cause any harm to the baby by undergoing procedures with high levels of x-rays or heavy metals contrast. So, for screenings throughout pregnancy, I resort to clinical breast exams and should any concerns arise, an ultrasound is safe and the first step we’d take to check everything out.

I continue to do my monthly breast self-exams (don’t listen to what the American Cancer Society says, these continue to be important for everyone!). This has honestly been very difficult for me emotionally throughout pregnancy for several reasons. One, being that I found my lump myself so there is a bit of PTSD there… and, two, because TNBC is notorious for popping up in the pregnant/postpartum phase. With many changes happening in my body during pregnancy (normal), finding a lump is not my favorite thing to think about. I say this only to validate others who may be experiencing the same thing!

Lastly, last year I requested to start doing blood draws twice annually which can specifically detect my tumor’s unique DNA in my system. This test is run by Natera Genetics and is commonly used with more advanced stage disease to ensure treatments are working. It is generally not indicated for early stage survivors as there is no protocol for “next steps” should any elevation of circulating tumor cells be detected.

However, knowing that I was intending to get pregnant and screening options would be limited, my doctor magically got my insurance to cover this for me and my most recent test does NOT indicate any signs of recurrence – yay!

As scary as it can feel to pursue pregnancy and parenthood with a not-so-distant cancer diagnosis, there are options to continue screening throughout pregnancy. I find that mindset is so important, and I remind myself on a daily basis that my baby and I are healthy and thriving through this pregnancy and it keeps me present.

Non-Cancery Curve Balls

Honestly, I’ve been very lucky to have a relatively uneventful pregnancy thus far. I tell most people I did it backwards since I felt so well throughout my first trimester and have had a slow decline in energy and motivation after getting halfway through my second trimester.

I did find out early on that my Rh- blood type means I need a Rhogam shot so my body’s antibodies don’t attack the baby’s if their blood type is Rh+ so I’m heading to get that later today.

I learned the hard way that Paxlovid can be taken during pregnancy if you get COVID-19 with moderate to severe symptoms. However, from my brief research, the U.S. is currently the only country deeming it safe for pregnant women/fetuses so I opted not to take it. I primarily blame COVID (& not the tiny human growing inside) for my listlessness these days…

And, as it turns out, the 1-hour glucose screening test is made to be quite difficult to pass. Obviously, it would not be great to allow someone to go through pregnancy with undiagnosed gestational diabetes. So here I sit, waiting to complete my 3-hour glucose tolerance test. As inconvenient as these tests can be, it’s all for the health of mama and baby, and I’d rather make a few lifestyle changes to get us both safely to somewhere closer to our December due date!

Beyond all that, I’m just immensely grateful to be on this post-cancer, prenatal journey with my incredible hubs and family and friends who’ve been the ultimate support. As I start my third trimester, I am definitely in nesting mode and doing my best to connect to this little soul that I’ll get to bring earthside in a few short months!

I’ll be scaling back my work days at the end of the month, testing out for my official Pilates certifcation in the next few weeks, and prepping for a few upcoming education opportunities on the state and national levels!

My last reminder today is that while we all may have good intentions for Breast Cancer Awareness Month this October, please check who benefits from your dollars spent before you buy anything PINK! My favorite organizations to donate to that support breast cancer research or survivors themselves include:

Click on the links to donate! And don’t forget to do your self-exams and schedule your annual screenings!

Aloha ❤

Cancer, Sex, & Intimacy

Cancer, Sex, & Intimacy

by bridewitt ♥ 1 Comment

Cancer isn’t pretty. Besides generally feeling unwell, the hair loss, body composition changes, aches and pains, and hormonal fluctuations are not exactly sexy. Having cancer (or loving someone who does) can certainly challenge intimate relationships. It’s important for cancer warriors to know this isn’t unusual and there are plenty of ways to maintain healthy relationships with their partners ❤

Some cancer- or treatment-related challenges that may affect someone’s sexual function, sexuality, or intimacy with their partner can include:

  • Chemo side effects including fatigue, nausea/vomiting, weight loss/gain, or infertility concerns (etc, etc, etc….)
  • Post-surgical or post-radiation considerations like:
    • pain or restrictions from scar tissue or irradiated tissues (especially with cancer of the reproductive organs)
    • decreased sensation around the nipples after mastectomy
    • urinary incontinence or erectile dysfunction post-prostatectomy
  • New medications that reduce desire or arousal
  • Hormonal changes resulting in low libido, vaginal dryness, or painful sex
  • Body image concerns including attractiveness to self or partner
  • Depression, anxiety, or PTSD surrounding a cancer diagnosis and treatment

There are many ways that pelvic floor physical therapists (PFPTs) can help support both men and women during and after cancer in this realm. PFPTs can treat the physical changes that come with cancer including post-surgical rehab or prescribe general strength/aerobic training. We can treat incontinence after surgery or radiation. We can recommend sexual positions or devices to reduce or eliminate pain with sex. And sometimes, we help our patients find new ways to connect with their partners when they’re not ready to be sexually intimate yet.

Often, seeing a licensed counselor or psychologist for individual and/or couples therapy can be very helpful to maintain or restore intimacy. Remember, cancer is not pretty, and there is no shame in asking for help! If you’re having concerns or challenges in your relationship, please reach out to me to see if pelvic floor PT or a referral to a mental health professional might be right for you.

Aloha ❤

*This blog is part 3 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Cancer & Pelvic Pain Conditions

Cancer & Pelvic Pain Conditions

by bridewitt ♥ 1 Comment

On today’s blog, I wanted to bring attention to female pelvic pain and dyspareunia (pain with intercourse) secondary to cancer treatments.

Often, when a woman has gone through adjuvant hormonal treatments, chemotherapy, abdominal/pelvic radiation, or fertility-saving drugs during active treatment, the body goes into a state of menopause or “chemopause” as it’s commonly referred to in the cancer world.

Low estrogen levels during chemopause can cause symptoms like:

  • Amenorrhea (loss of menstrual cycle)
  • Low libido
  • Vaginal dryness or atrophy
  • Hot flashes
  • Mood changes
  • Joint aches and pains

In particular, vaginal dryness or atrophy can have a huge impact on sexual health, emotional health, and relationships post-cancer. If the pelvic floor muscles are compromised by treatment, it can result in pelvic pain (like pain from overactive or tight pelvic floor muscles, pain in the tailbone, lower abdominal pain, or pain around post-surgical scars), bladder/bowel changes, or painful sex.

Thankfully, a pelvic floor physical therapist with specialized training in examination and treatment of the pelvic floor muscles can treat these conditions and are an amazing asset to oncology patients on their road to recovery. Some PT treatments for pelvic pain and dyspareunia may involve:

  • Pelvic floor muscle strengthening or relaxation exercises with or without biofeedback training (computer or ultrasound-based pelvic floor training technology)
  • Stretches for tight muscles around the abdomen, pelvis or hips
  • Manual therapy including general massage, pelvic floor muscle release techniques, or scar tissue mobilization
  • Education and lifestyle strategies surrounding posture, nutrition, bowel and bladder habits, and lubrication options during intercourse
  • Education in the use of vaginal dilators to reduce pain that occurs with tampon insertion, gynecological exams, or sex
  • Encouragement around body image and sexual health (this could include referral to a sex therapist or psychologist when appropriate)

If you’re reading this, and you feel like you could benefit from pelvic floor physical therapy during or after cancer treatment, you can find a qualified pelvic floor PT in your area here or here. Ask your doctor for a referral today!

And a quick reminder for all of us…
The path to recovery from cancer involves a whole host of treatments including chemo, hormonal treatments, surgery, and radiation just to name a few. Each of these treatments can come with significant side effects or long-lasting comorbidities. Just because someone is “cured” from cancer doesn’t always mean they are living without long-term effects from treatment. Keep this in mind, and be kind!

*This blog is part 2 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Chemo & Constipation

Chemo & Constipation

by bridewitt ♥ 0 Leave a Comment

Chemo and constipation. Oh, poop! As a pelvic floor physical therapist and breast cancer thriver who is currently in the home stretch of chemotherapy, I can personally testify that constipation is no joke!

Having regular bowel movements during chemo is important to help detox the body of chemotherapy medications. In doing so, other side effects of chemo can be reduced. Backed-up bowels can contribute to or worsen nausea and vomiting. Unmanaged constipation during chemo can cause painful hemorrhoids or anal fissures that can put a patient at risk of infection while immunocompromised.

So how do we treat or avoid constipation during chemo? Well, let’s start with the basics and go from there…

What is constipation?

Typically, a person should expect to have a bowel movement anywhere from three times per day to three times per week. Stools should be soft and easy to pass (like #3 or 4 on the Bristol Stool Chart below). You may have constipation if your bowel movements are irregular (several days pass between BM’s) or your stool is very firm and is painful or requires straining to pass. Sometimes, it may feel that you’re not able to empty your bowels completely as well.

Borrowed from abc.net.au1

What causes constipation?

Generally, constipation is related to not getting enough water or fiber in your diet. It can also be from not getting enough exercise or from changing your routine when you travel. Unfortunately for some people going through cancer treatment, certain chemotherapy medications can cause gastroparesis (slow or paused digestion of food), which can lead to constipation.

How can you relieve constipation?

*Drink warm liquids (water, tea, coffee) first thing in the morning to kick start digestion and bowel movements, and be sure to drink plenty of water throughout the day (aim to drink half your body weight in ounces of water).

*Exercise! Take a short 10-15 minute walk or try these gentle stretches to stimulate the bowels.

  • Supine Twist Stretch
  • Happy Baby Pose
  • Seated Twist Stretch
Courtesy of MedBridge Education2

*Eat plenty of fiber. Try to eat 25-30 grams of fiber daily with foods like broccoli, Brussels sprouts, beans, lentils, oatmeal or whole grains.

*Practice good toileting habits:

  • Use proper pooping posture – place your feet on a stool or rest your elbows on your knees to make it easier to empty the rectum.
  • Relax your pelvic floor muscles & breathe!
  • Don’t strain – come back later if you’ve got to push!
Borrowed from MacMillan Cancer Support3

*Try supplements and medications if the above fail. Ask your doctor about magnesium supplements, fiber/psyllium supplements (like Benefiber or Metamucil), stool softeners, or laxatives that might be helpful.

Remember: When it comes to constipation – consistency is key! Don’t scale back on your bowel routine because things begin to lighten up. During chemotherapy, you’ve got to stay on top of things to stay comfortable. If you need help getting a routine that works well for you, ask your doctor about a referral to a pelvic floor physical therapist in your area!

*This blog is part 1 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤