Heart Health & Breast Cancer

Heart Health & Breast Cancer

❤ February is American Heart Month ❤

Did you know that heart disease is the #1 leading cause of death for Americans and that 1 in 4 Americans will die of heart disease each year?

Did you also know that women who’ve had certain types of cancer treatments are at a greater risk for heart disease as well? As treatments for breast cancer have advanced, more breast cancer survivors are living with these long-term consequences of treatments. Some treatments known to have adverse effects on the heart include:

  • Chemotherapeutic agents:
    • Anthracyclines (doxorubicin, epirubicin…a.k.a. “red devil”)
    • Anti-HER2 Agents (herceptin, perjeta)
  • Hormonal therapies (tamoxifen, anastrozole, letrozole)
  • Radiation to the breast/chest wall

For all of the treatments listed above, risk of cardiovascular disease including coronary artery disease and cardiomyopathies (dysfunction of the heart muscle) is elevated. Evidence of cardiotoxicity can show up several months to several years after these treatments are administered. So what does the research say about prevention or reversal of these cardiac side effects?

Prevention of Cardiotoxicity during Cancer Treatments

Firstly, anyone starting any of the above-listed treatments should undergo a baseline cardiac function screening such as an EKG and electrocardiogram to allow for close monitoring of the heart once treatment is administered or completed. Doctors will specifically watch the left ventricle ejection fraction which is an indicator of how well the heart can pump blood to the body.

The benefits of eating a healthy diet full of fruits, vegetables, and whole grains and maintaining a consistent exercise routine during treatment also apply to cancer patients (we’ll discuss this more in a minute). Avoidance of smoking and drinking alcohol is also very important.

From a medical standpoint, oncologists can specify the dosage, timing, and frequency of chemotherapy treatments to minimize their effects on the heart. In some instances, they can prescribe a cardioprotective medication such as a beta-blocker or ACE inhibitor to reduce strain on the heart during chemotherapy, especially if a patient is symptomatic.

Some symptoms that may indicate heart concerns include:

  • shortness of breath
  • swelling in the feet or lower legs
  • rapid or irregular heart beat
  • pain or swelling in the abdomen
  • mental confusion

During radiation, the heart is most at risk if the left side is being treated. Radiation oncologists can have a person use a deep breath hold to minimize the risk of radiation to the heart. They use the radiation simulation to plan the most effective delivery of radiation and ever-advancing treatment techniques to reduce the dose of radiation to the heart.

As you can see, there are many ways to be proactive about heart health during cancer treatment. Patient should never feel as though it’s inevitable to come out on the other side of treatment with heart problems!

Management of Treatment-Related Cardiotoxicity

Should a person develop cardiac issues during cancer treatments, there are more and more evidence-based guidelines emerging for how to improve cardiac function and prevent long-term health consequences. In many cases, treatment-related heart conditions are reversible!

Just like any other muscle in the body, the heart needs to be challenged to get stronger. During cancer treatments, people tend to lose about 27% of their exercise capacity. This means that, as a survivor, it’s time to get in shape.

Ideally, patients and survivors are recommended to get 150 minutes of moderate aerobic exercise per week – that’s about 30 minutes, five days per week. Walking is a great place to start, but patients should choose their favorite type of exercise! Aerobic exercise like running, biking, swimming, or high-intensity interval training (HIIT) are very effective ways to promote healthy heart function. Those who consistently get 150 minutes per week are also shown to reduce their risk of mortality by up to 60% – perks!

From a physical therapy perspective, supervised exercise is best for a few reasons. A knowledgeable physical therapist or exercise physiologist can help prescribe exercise according to guidelines related to the phase of treatment someone is in. Someone in active treatment should not be exercising at the same intensity as a survivor who is 6-12 months out of treatment. Just like recovery from an injury, exercise progression should be progressive and individualized!

Cardiotoxicity is a serious side effect of cancer treatments and should not be overlooked. There are many options for prevention and management of heart conditions that arise for cancer patients and survivors. To find a physical therapist or exercise physiologist who is experienced working with oncology patients, ask your physician for a referral to a trusted provider in your area or use the APTA Find a PT locator!

Sending love to you!

Aloha ❤

To read more, check out these articles:
1. Cardiotoxicity of Contemporary Breast Cancer Treatments (Chuy, et al.)
2. Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity (Avila, et al.)

5 Things I Learned from A Naturopath

5 Things I Learned from A Naturopath

It’s no secret that I am freakishly in-tune with my body and that I also value knowing exactly what’s happening behind the scenes of my symptoms. Even before I was diagnosed with breast cancer, I knew something was off with my body, and I’d started to research root causes and naturopathic/functional medicine approaches to help me with some things I’d been experiencing. Then, cancer came into my life and between the 85 million appointments (not exaggerating…), I decided to hold off on seeing yet another practitioner.

Now that I’m approaching the end of active cancer treatment, I decided it’s time to get some additional support and testing done. A few things I was concerned about include the health of my digestive system, support for my thyroid, and restoring equilibrium for my female hormones. I chose to see a naturopath (ND) based on recommendations from friends and based on her experience level and social media content (never underestimate the power of social media!). Here’s a few things I’ve learned after my initial consultation and lab work:

Get that Good Gut Health

Chemo is designed to destroy cancer cells which are typically rapidly dividing and multiplying in our bodies. Well – guess what else rapidly divides and multiplies? Healthy cells in our digestive tracts! Side effects from chemotherapy tend to hit the GI tract hard and can include mouth sores, nausea/vomiting, heartburn, and diarrhea or constipation. Seeing as I had several of these symptoms during my 16 rounds of chemo, I knew my gut was going to need support and healing.

First of all, the GI tract is full of trillions of happy, healthy bacteria typically referred to as the gut microbiome. These bacteria help us to digest food and maintain a strong immune system. It’s all a bit complex honestly, but a lack in diversity of these bacteria can lead to a whole host of health issues, including mental health concerns.

My ND recommended a few important things to get me started: a good probiotic to promote microbiome diversity and a drink called GI Revive which supports the intestinal lining and promotes regularity. It’s also crucial to eat a diverse, supportive diet that includes plenty of fiber, vegetables and whole grains, and fermented foods.
*Side note – if I’d known GI Revive existed, I would have started it during chemotherapy. However at that time, I did use L-glutamine supplements which helped me prevent issues in my mouth and lower GI tract.

Altogether, I feel like things are coming back around to normal after chemotherapy with this added support. I imagine that the more my gut heals, the more I’ll see my immune system improve and I’ll be able to maintain low levels of inflammation in my body.

Clarity on Chemopause

I started chemo on June 9, 2020, and that was also the first day I received a Zoladex injection. Zoladex is a hormonal therapy designed to stop the ovaries from creating follicles which release estrogen. The ovaries have a high rate of cell turnover like the GI tract, so chemotherapy can lead to infertility if not protected by hormonal therapy. Modern medicine is truly incredible, and I’m grateful that as a 30-year-old woman going through chemo, I had the option to try to save my fertility in this way.

Joke’s on me though, because after 6 months of this hormonal therapy, I am officially in chemopause (a medically-induced menopause), and I have all the symptoms to show for it. I specifically asked my ND for post-chemo baseline labs for my estrogen, progesterone, and testosterone levels. No surprise here, but my labs confirm I’m in a menopausal state and that explains the hot flashes, joint pain, dyspareunia (learn more here), and amenorrhea…

Now, true menopause means a woman has had no menstrual cycle for >12 months. Being only two months out from my last Zoladex injection, I’d say there’s still hope for my ovaries to bounce back. Most women who’ve been on this type of treatment have seen their menstrual cycles return after 5-6 months on average. In the meantime, I need to be supportive of my body! I attempt to exercise 3-5 times per week (walking, resistance training, and stretching) to relieve joint pain and both my ND and OB/GYN have recommended vaginal moisturizers to prevent vaginal atrophy until my estrogen levels improve. (If this is TMI for my family & friends reading this – sorry, but it’s just #RealTalk!)

I’ll continue to monitor my labs every few months to be sure things are trending in the right direction. Chemopause isn’t necessarily permanent, so here’s hoping my body can pull through!

The Thyroid Needs to Thrive

About seven years ago, while I was deep in PT school, I began having unnatural fatigue. I ended up being diagnosed with an underactive thyroid gland (hypothyroidism). The thyroid gland produces hormones which help regulate our metabolism, and if the thyroid isn’t functioning optimally, you can have symptoms like fatigue, dry skin, hair loss, weight gain, constipation, or feeling like you’re always cold. Every body system relies on the thyroid so it’s a priority to take care of it!

Trying to find the root cause of my thyroid dysfunction has always been something I was curious about before my cancer diagnosis, and after treatment I wanted to know if there was: a) any additional support needed for my thyroid after chemo, and b) if there was an underlying cause for my hypothyroidism. After running a full thyroid panel, my ND diagnosed me with Hashimoto’s thyroiditis, an autoimmune condition in which my own immune system is attacking my thyroid. She educated me that Hashimoto’s is actually the most common cause of hypothyroidism and affects about 5 in 100 people.1 It seems that Hashimoto’s is a combination of genetic factors and environmental factors such as food sensitivities or heavy metals toxicity.

My next step is to try to determine what may have triggered this autoimmune condition. The more I know about my condition, the better I can treat it or avoid any sensitivities that may make my condition worse. It might seem like I am seeking out more health problems, but my intent is really to understand my own body and how I can best support it to remain healthy and cancer-free. I will likely always have to be on thyroid medication, but I’d like to try to prevent the condition from progressing as much as I can (I plan on living a long life, you know?!).

Sometimes You Just Have to Supplement

In all honesty, I’ve never been a fan of supplements because I just can’t remember to take them every day! I now understand, however, that there are certain vitamins and minerals that I’m unable to get enough of through a vegan/vegetarian diet (like vitamin B12 which is only found in animal products), and also, based on my recent lab work, we found that some others (like my vitamin D and zinc levels) were significantly depleted for me during chemotherapy.

There are certain supplements I need to be cautious taking during radiation therapy as high levels of antioxidants (like those in vitamins A, C, and E) can interfere with the treatment itself. For now, I am supplementing with:

  • B vitamin complex to improve my energy levels and cognitive functioning
  • Vitamin D3 which promotes bone health and has been shown to reduce the risk of cancer metastasis
  • Omega-3 which helps to reduce inflammation and supports brain and heart function
  • Zinc which supports the immune system
  • A probiotic and the GI drink I mentioned earlier for gut health

It sounds like a lot, but I’m currently finding it very worthwhile. Some of the brain fog that started during chemo has lifted since I started supplementing more regularly, my GI system is more settled, and my hair is growing back much faster than I anticipated! Maybe eventually I won’t need so much supplementation, but I feel now is the time to be very supportive of my body and it’s healing.

The Cost of Collaborative Care is: Priceless.

I know what you’re all thinking – this all sounds expensive! And it is to some extent. Supplements can be pricey & aren’t covered by insurance like most pharmaceuticals. When providers don’t contract with insurance companies, the costs can add up. I don’t need to explain myself, but I just want to let you all in on my thought process at this point.

Seeing an ND and using supplements and acupuncture to support my healing have brought me immense benefits and peace of mind both before and after my cancer diagnosis. I personally feel that seeing a fee-for-service provider is excellent because they are not held to unreasonable standards that insurance companies often dictate. These providers can spend more 1:1 time with their patients, can recommend tests and treatments that can be run through insurance companies, and can provide a more holistic approach to your care. I personally feel it worth every penny to have this kind of care.

If you don’t have your health, you have nothing. This year my body has been through the ringer and besides feeling physically unwell, I saw my mental health and my relationships challenged. I was hardly able to concentrate on anything besides getting through treatment and managing my symptoms. My husband became a “caregiver” and most of our life revolved around what I could and couldn’t do with friends during a pandemic when you’re immunocompromised. I haven’t been able to treat patients for almost a year and so my sense of purpose got a little muddy at times.

Now is the time for me to heal from all of that. I am beyond grateful for good health insurance that got me through treatment without any debt, family and friends who contributed to my GoFundMe so I can seek out alternative care options as I continue to heal, and for my super-supportive coworkers who’ve donated time off and kept me in the loop at work so I don’t feel like a complete outsider. These things may seem small, but they can mean the world to someone living with a complex illness.

Again, my purpose here is to share my journey in case someone else going through this can benefit from what I’ve learned. Much of this info is very personal, and I choose to be open about this. I’ve said this before, but just because someone is considered “cancer-free” doesn’t mean they’re not still experiencing some of the long-term effects of treatment. We use fire to fight fires in cancer care and there are often side effects of side effects!

Please be kind! If you know someone in treatment (or if you know someone who may just need a little extra help), reach out today and see how you can support them – we’ve all got to have each other’s backs.

Aloha ❤

*This post is not intended to provide medical advice or recommendations. I am simply stating what has worked or been recommended to me on my personal journey. For more information, read my full disclaimer here.

Stronger than Cancer

Stronger than Cancer

According to the National Cancer Institute, as of January 2019, the United States had 16.9 million cancer survivors and estimates that number will increase to 22.2 million by the year 2030.1 Although I’m still technically in active treatment until I complete radiation therapy, I’m now considered NED (no evidence of disease) a.k.a. “cancer free,” a survivor. While it would seem that being a survivor is just one big party, I’ve found myself seeing from a perspective that people who haven’t gone through cancer may not consider. Today, I have a few thoughts on survivorship that I wanted to share – it’s a long one, but an important one so get comfy…

Survivor or Thriver?

In the true sense of the word, a survivor is someone who’s overcome hardship or who copes well with the challenges they’ve been given. For some of us who’ve lived or are living through cancer, surviving doesn’t quite describe what it’s like to take on a complex illness and somehow maintain a semi-normal life. That’s why many in the cancer community now prefer the term “thriver” because they choose to continue to not only survive, but thrive through and beyond a cancer diagnosis. It’s not about getting through it without complications, but rather just living as normally as possible during treatment. Being a thriver means rolling with the punches, accepting what you have to do to get through it all, and getting to live how you want despite your diagnosis.

Being a thriver takes on a whole new meaning, though, for someone with metastatic/stage IV cancer. As of now, there’s no true cure for Stage IV cancer and treatment continues until the cancer doesn’t respond anymore. However, many people live for years on palliative treatment since research and treatments continue to advance all the time (#StageIVNeedsMore). In the meantime, there is always normal life running parallel to someone’s diagnosis. The world doesn’t just stop turning. I bring this up only to remind you that everyone’s diagnosis is different – not everyone can be cured, and it seems unfair to put “surviving” on a pedestal when, honestly, what it takes to thrive after a cancer diagnosis is so much more honorable.

If you’re interested in donating to support Stage IV breast cancer reseach, click here.

Mental Health after Cancer

Despite much stigma around mental illness in the past, I think the narrative about mental health issues is gradually (thankfully) starting to change. Many of us experience some degree of mental health concerns throughout our lifetime, but there are a few specific things that someone with cancer may go through after diagnosis and especially in the years after someone may be considered NED.

Scanxiety is the term used by cancer thrivers to convey anxiety around pending imaging (mammogram, CT/PET scans, etc.) or about the results of them. Imaging is the first stop on the cancer diagnosis train and so repeating this process every six months to a year can bring up a lot of emotions, even if it’s expected the scan results will all be normal. It’s important to recognize these feelings are normal and expected (especially in those first 5 years after diagnosis when the likelihood of recurrence is highest), and this would be a good time to throw your toxic positivity out the window. Here are a few ways to be there for someone preparing for follow up scans:

Don’t say….

“Everything will be fine…”

“You have nothing to worry about…”

“It’s just an MRI/CT/mammogram…”

“Stay positive – negative thoughts only lead to disease…”

Instead try….

“I know you’re worried about your tests/results, do you want to talk about it?”

“It’s ok to feel [insert emotion here] after all you’ve been through.”

“Do you want to go for a walk/coffee/other activity to take your mind off all of this for a bit?”

Post-Traumatic Stress Disorder, another anxiety condition, is widely publicized as something that combat veterans get after serving in war. Fun fact – anyone who has been through any kind of trauma can get PTSD. After being diagnosed with cancer, there are so many things that can trigger anxiety and panic attacks. A few of my triggers include hearing of someone young who died of cancer, upcoming medical appointments (particularly with new doctors or doctors that don’t know my recent medical history), and especially blood draws, but other events or news may trigger someone differently. Please be kind and allow space for others to feel their stress and anxiety.

Another thing I’d like to address is actually the first thing I experienced after surgery confirmed I was NED. Survivor’s guilt. I was surprised that I felt this since I was very confident in my doctors and myself that I would get through this (I guess when you’re doctor writes on your FMLA paperwork that your cancer is “curable” it leaves you mostly hopeful). But this “guilt” hit me hard and unexpectedly and so I’ve taken some time to sit with it and understand it.

Truthfully, I don’t actually feel guilty that I survived cancer. I know many other survivors and have met many amazing women this year who’ve overcome a breast cancer hurdle, and they never talk about feeling guilty to be alive either. So I came to the realization that what I’m feeling is actually empathy for those still in treatment and compassion for those who will always be in treatment or for whom treatment didn’t work. Being a survivor is a strange position to be in, but I’m hoping that my experience will only make me a better friend and clinician when I have the opportunity to support someone going through a similar experience.

Expectation of Transformation

The one last thing that’s been on my mind is this idea that because I’ve survived cancer, I must be a changed person. Cancer is eye-opening in many ways, that’s true, but it’s not like Cinderella putting on that glass slipper. I don’t suddenly have this new lease on life, and I don’t feel newly inspired to pick up the torch and run wildly toward some new life where every experience is profoundly meaningful and joyous. That’s great if someone else does have a big transformation, but for me (and likely many others) it’s just not the case. Instead, I feel a bit more reserved. I want to live a simple, mostly happy (sometimes messy) life focused on loving the people I surround myself with and learning as much as I can with whatever time I have left here on this Earth.

I don’t strive to be an inspiration and I hope everyone can recognize that a diagnosis isn’t a definition. I had cancer. I am not defined by that or limited to that. I share my experience because I hope it can help someone else who’s going through it. While I’ve learned a lot, I’m not going to dwell on the experience. Instead, I’ll take what I’ve learned and get back to my life, applying that new knowledge whenever I get the chance. I hope you’ll all hold me accountable to that.

Aloha ❤

Happy New Year!

Happy New Year!

Well, we did it. We made it through 2020, a year no one could have ever expected. A year that we were all “safer at home” and “socially distanced.” A year in which we all struggled as a collective against a common enemy and were challenged on a personal level as well.

It’s easy to look back on this as a very difficult year, but for me it was also a year of major growth, learning, and finding love. Love for myself, my partner, my family and friends, and even for strangers. A year to prioritize my health, both physically and mentally. A year to allow many tears and also to find joy in the most ordinary of days.

I’m actually unable to hold back tears thinking of all we went through this year with such little reprieve. To go through cancer on top of it all was just ridiculous, honestly. So, I am grateful to sit here and reflect on the highs and lows of 2020. I am even more grateful to be able to look ahead to the ordinary joys, the eventual hugs, and the lessons that 2021 will bring.

I know I’ve mentioned this before, but on my 30th birthday last year, I kept feeling that 2020 would be a big year. Not like the “best year ever” kind of year, but the kind where you’re challenged in all the important ways. I usually decide on a word that symbolizes my intentions for the year, and I just couldn’t pick one last year, but as the second quarter of the year began with COVID and a cancer diagnosis, I found myself always coming back to a Japanese phrase I learned a few years ago:

And so that’s what I’ve done this year. I just kept putting one foot in front of the other and doing the best I could to get through each day. Trust me, some days were better than others and there were many days that I had to ask for help. So to those of you who prayed for me, who let me cry with you on the phone, who laughed with me on zoom calls, who sent cards and letters, who wore masks & socially distanced to protect the immunocompromised – I am incredibly thankful for you.

A few highlights from this year:
Getting to spend a whole month with my mom in Hawaii. Staycations. Cooking at home and learning new recipes. Being outside more often. Meeting new people (mainly my excellent medical team and an incredible group of cancer thrivers). Growing closer to my husband as we rounded out our second year of marriage and head into our third. Working on my Pilates certification. New babies. Friends getting married. Learning my own strength.

I won’t dwell on the lows, but I will remember how much I learned from them. This year my word is JOY. I hope to find more joy in each day, be more present, and celebrate every little victory. There will be setbacks, I’m sure of it, but if I’ve learned anything this year, it’s that they can be overcome. Wishing you all a happy, healthy, safe new year and sending you so much love and gratitude.

Cheers to 2021! ❤

A Fertility Update

A Fertility Update

How it’s going…

You may remember me posting a while back about the different ways I tried to protect my fertility as I prepared to start chemotherapy. First, I froze some eggs. In case I’m unable to conceive naturally later, I can use them for IVF. I also started monthly Zoladex injections – a medication that halts ovarian function in an attempt to preserve fertility overall.

And so, at age 31, I’ve been in a Zoladex-induced menopause since June. Six whole months later, my estrogen levels have tanked and my joints ache like I’m an 100-year-old lady! Some other fun side effects include amenorrhea (lack of a period), hot flashes, and dyspareunia. So, I’m currently staying as active as possible (mostly walking and stretching when I have the energy) in order to mitigate some of those side effects, and thankfully, my oncologist and I decided it was time to discontinue the Zoladex now that the bulk of treatment is behind me. Today marks one month since my last injection!

For more detailed info about fertility preservation, you can read my earlier post here.

What to expect now?

Typically, the menstrual cycle can take a few months to return as the body figures out its new normal once again. As I have some previous experience with amenorrhea after I came off the birth control pill in 2019, I know that what I eat will play a huge role in how quickly my body gets back to normal. Thus, the plant-based diet continues (plus no dairy, processed sugars, or alcohol) and I will try my absolute hardest to cut back on caffeine to keep my nervous system calm.

I also plan to use seed cycling to help my body regulate the essential hormones it needs for menstruation and ovulation. This is a great article about how to do seed cycling if you’re interested in learning more. Seed cycling is an excellent, natural way to balance hormones, however if you have hormone-positive cancer, please ask your doctor if a daily dose of phytoestrogens is safe for you!

Once I’ve completed radiation therapy, I’ll speak with my medical oncologist and OB/GYN about when it will be safe to start trying to conceive. With that said, I think my body deserves a long break to heal completely before that all happens. Actually, this might be a good time to kindly remind you that it’s just not acceptable to ask a person when they plan to have children. A person’s body is their own to make decisions for and, sometimes, people aren’t capable or willing to have children at all.

My goal for this blog has always been to be as open and honest about my experiences as possible in the hopes that whoever may be reading this can gain some insight for their own health and wellness. Personally, I don’t think there’s ever TMI (too much information) disclosed when it comes to learning about your own body and how it works. This coming from a pelvic floor PT who talks about poop all day… Anyway, I’d love to know what questions you have about:

  • fertility preservation during cancer treatments
  • long-term side effects of the birth control pill
  • nutrition around hormone balance
  • seed cycling

Drop your Q’s in the comments below!

P.C.R.

P.C.R.

Today is December 1. The first day of the last month of the absolute craziest year of our lives AND the start of birthday month! Thought I’d give you a little update on surgery and the excellent news I received today.

Thankful.

Last Friday, I had a lumpectomy and sentinel lymph node biopsy. I checked in at 5:30 am, had wires inserted into my tumor and into the lymph node that was “suspicious” at the time of my original diagnosis. My radiologist placed these wires guided by ultrasound imaging. Once the wires were securely in place, I was sent to nuclear medicine for lymphoscintigraphy. A radioactive tracer dye is injected near the site of my tumor and imaging is used to identify the first lymph node to which the tumor drains so it can be removed during surgery.

During surgery, the nodes are removed first and sent for preliminary pathology while the surgeon removes the tumor and a small margin of tissue. After surgery, the nodes and tumor are examined in more detail by the pathologist for any remaining cancer cells.

My preliminary pathology on the lymph nodes was negative and today (post-op day 4) my formal path report came back and indicated what’s called a pathologic complete response (PCR). PCR means that no residual cancer cells were found in the tumor bed or in the lymph nodes at all – CANCER FREE! PCR occurs in about 30% of people who have triple negative breast cancer (according to my surgeon), and this is absolutely the best possible outcome I could have asked for! I hope you’ll all celebrate with me this week.

5 1/2 weeks post-chemo hair growth!

As far as recovery from surgery, everything is going pretty well. Pain and swelling are both mild. I was instructed to leave my bandages on until my follow up with my surgeon on Thursday this week. I’ve been doing some really basic range of motion exercises for my neck, shoulder blades, elbow and wrist to help move the lymph and prevent any significant stiffness. My PT & lovely coworker suggested I don’t lift my left arm above shoulder height for the first several weeks to allow the lymphatics in my armpit to heal and try to prevent axillary cording (which I’m at higher risk for) and lymphedema (which I’m at lower risk for).

Just want to say another quick THANK YOU to all of you who’ve supported me and prayed for me. God is good, and I am so relieved by the pathology results. Next step is radiation, and I should find out more this week about what that may entail.

**Quick reminder: December 1 means it’s time to check your chest – do your self-exams and schedule your preventative screenings!

#FeelItOnTheFirst

Sending alllll the aloha to you all today ❤

Cardiovascular Testing during Cancer Treatment

Cardiovascular Testing during Cancer Treatment

Hey, all! I wanted to give a quick update about the exercise capacity testing I did over the weekend. In college, I majored in exercise physiology, and as a physical therapist, I apply Ex Phys principles daily, so it was important for me to have an idea of my baseline physical fitness and my post-treatment fitness so I can work my way back up again.
*NOTE: If you don’t feel like reading, catch my video at the end of this post!

What is exercise capacity testing?

Exercise capacity testing is used to determine cardiorespiratory fitness. The test that I used for myself is a cardiac “stress test” which is a graded treadmill test that is used to estimate peak exercise tolerance (VO2max). I used the Bruce protocol which gradually increases the speed and incline of walking (exercise intensity) over 3-minute intervals.

Because I was unable to complete a “true VO2max” test, I used an equation to estimate my peak exercise tolerance which is the best I can do without lots of fancy equipment!

Why complete an exercise capacity test?

Cancer treatment can result in significant physical decline, and some types of chemotherapy can affect the heart function (both in the short or long-term). I feel like every person undergoing cancer treatment can benefit from a supervised cardiovascular testing to guide their aerobic training as they complete cancer treatment and as they recover when treatment is done.

Personally, I wanted to know my baseline and post-treatment measures in order to better guide my usual aerobic exercise training program. Because my primary goal during cancer treatment is to heal my body, I do not want to overexercise and delay the healing process. I have continued to exercise at a lower intensity throughout chemotherapy (primarily walking 3-4 days per week for 20-30+ minutes and body weight resistance training) and I know it has helped me reduce fatigue and bone/muscle pain, improved my mental health, and helped manage weight changes and lymphatic drainage.

What does the treadmill test measure?

For the treadmill test, I kept track of:

  • Resting heart rate (HR) – normal range is 60-100 beats per minute
  • Interval HR – should gradually increase as exercise intensity increases
  • Resting blood pressure (BP) – normal is <120/<80 mmHg
  • Interval BP – should stay the same or increase slightly as exercise intensity increases
  • Rate of Perceived Exertion (RPE) – subjective measure of how hard someone is exercising – should increase as exercise intensity increases
  • Dyspnea Scale – subjective measure of shortness of breath during exercise – should increase as exercise intensity increases

What were my results so far?

Despite maintaining a consistent aerobic program, I still saw a significant decline in my estimated VO2max. Prior to treatment, my estimated VO2max was 44 mL/kg/min, and at two weeks post-chemotherapy, my estimated VO2max is 31 mL/kg/min. I expected a decline for two reasons: 1) my aerobic training volume decreased significantly – no spin class during chemo & COVID (booooo!) and 2) chemotherapy and the cancer itself cause general changes in our body’s physiology that we can’t 100% control.

I noticed that my resting HR increased during chemotherapy (which my oncologist said is normal), but this likely decreases my exercise tolerance as well. I actually stopped my post-chemo test a bit early because my HR was getting so high!

Like I said, I did a pre-treatment test, now a post-chemo test, and I’ll continue to repeat the testing every 3 months over the next year or so to make sure I am able to get back to (or at least close to) my baseline and also to be sure I can bring up any concerns to my doctor should they arise.

How can you get an exercise capacity test done?

Not all physical therapists are alike in this case, and many do not perform exercise capacity testing, however certain PT’s or clinics in your area may offer these tests in a modified capacity (like I did). Call ahead to some PT clinics in the area to see if they can offer these services to you and ask your oncologist for a referral before you begin treatment. If you’re having difficulty finding a physical therapy clinic that offers this service, you may be able to work with an exercise physiologist or cardiac rehab specialist who does similar stress tests at local hospitals.

An important thing to note: I used the Bruce protocol initially because I was unaware that there has been a specific protocol developed for the oncology population through the University of Northern Colorado Cancer Rehabilitation Institute. They have also developed normative VO2 values for the oncology population as well, so be sure that whoever does your testing is aware of this option!

Check out the video below for a little more detail on my results & the testing process!

I’ll see my surgeon tomorrow to make a plan for surgery & determine what some of the next steps may be – wish me luck! Hope you all have a great week & that you’re taking care of yourself with all of the election energy in the air — Don’t forget to wash your hands & social distance, my friends!

Aloha ❤

Paying it Forward: Participation in Clinical Trials

Paying it Forward: Participation in Clinical Trials

In my last post, I described the side effects of taxane-based chemotherapy (aka taxol, paclitaxel, taxotere, or abraxane). We know that chemo-induced peripheral neuropathy (CIPN) is a large concern while undergoing these treatments. For me, as a physical therapist who uses my hands to guide my treatment, I jumped at the chance to participate in a clinical trial related to better understanding who is most likely to develop CIPN during chemo.

The study I’ll participate in is run by the University of Hawaii John A. Burns School of Medicine. It entails having several measures taken prior to taxane-based treatment (baseline), at 4-week intervals during treatment, and then several measures taken at various intervals up to 3 years post-treatment. The goal is to look at trends in which patients develop CIPN, how long CIPN lasts if developed, and if certain supplements or adjunct treatments (like acupuncture) help to prevent CIPN. In this way, doctors will be able to help patients make informed decisions to prevent this nasty side effect in the future.

Measurements taken include monofilament testing to measure protective sensation at various points on the feet, tuning fork assessment at bony points on the hands and forearm to measure vibratory sensation, a basic balance test call the Timed Up and Go which measures gait speed and safety, and several questionnaires which ask about loss of sensation, pain, sleep quality, physical activity, and general quality of life.

Even before I had officially met with my oncologist, I was hoping there would be a clinical trial that I could participate in. I feel that it’s a great way to pay it forward to others who will undergo similar treatments in the future. If they can have one less thing to worry about while navigating a super difficult time in life, then why not?

Clinical trials are very important, especially in the case of triple negative breast cancer. If enough evidence for specific treatments can be gathered, it could change the course of treatment for other patients in the future. As not much is actually known about TNBC since the tumors lack hormone or HER2 protein receptors, the exact same chemo regimen has been used to treat it for years! Thank goodness chemo is super effective! Here’s hoping new advances will be made to make treatment a little easier on everyone in the future.

If you’ve been diagnosed with cancer and you’re interested in participating in a clinical trial, ask your doctor if you qualify for any in your area. You can also go to clinicaltrials.gov and look up studies for your specific diagnosis and take ones that interest you with you to your next appointment to see if you do qualify.

There are many types of studies including observational studies (like the one I’m participating in) as well as randomized-controlled trials that may be testing new treatment options or options that make current treatments more effective. Remember, participation in a clinical trial is completely optional and if you start out with one, you can always opt out at any time. You don’t have to feel like a guinea pig if you don’t want to!

Feel free to reach out with any questions about joining or participating in a clinical trial!

xo

Round 1

Round 1

I had my first dose dense AC treatment on Tuesday, and so far it has gone better than anticipated. So far I’ve had a little nausea which I was able to manage well with some meds at home and I pretty much fall asleep any time I sit down on the couch, but all-in-all I’ve felt pretty good. Coming out of the fog a little bit today.

I also went in for my udenyca shot yesterday which helps to boost my white blood cell count. My oncologist actually gave me a slightly lower dose of this since, typically, younger people are more “robust” (as she put it) and can upregulate white blood cell count more easily. So far no significant side effects like bone pain, so I’m very thankful.

Round 1 – DONE!

I also haven’t had a chance to mention that I received my genetics results last week and I do not have a BRCA 1/2 mutation. This means that I’ll likely be able to choose a less aggressive surgery (lumpectomy v. mastectomy). It also means I have less chance of recurrence in my breasts or ovaries and it also means that my family members don’t have an increased risk of breast or ovarian cancer. Yay!

Just wanted to say thanks to everyone who’s reached out and who have sent very thoughtful gifts and prayers. I couldn’t get through any of this without you!

Especially a big thank you to my husband who is now head chef (ok, he always was), home pharmacist and water-bringer extraordinaire. So grateful for you, Justin ❤

Not the worst view from my chemo chair….

Hope you’re all doing well – will continue to update as much as I can. I’m hoping to get into work a few days next week if I’m feeling well enough.

xo